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NPI Code Detail

MEDICARE: DR. DAVID M NOONAN OD

MEDICARE: DR. DAVID M NOONAN OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1587NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NOONAN DAVID M 10028OTHERNCOPTICARE
2093G0OTHERNCBCBS
3NVAL28224OTHERNCSPECTERA

General Provider Information

NPI Number : 1225088503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID M NOONAN OD
Provider Business Mailing Address
First Line : 18419 DEMBRIDGE DR
Second Line :
City : DAVIDSON
State : NC
Zip : 28036-7819
Country : US
Telephone Number : 704-892-3817
Fax Number :
Provider Business Practice Location Address
First Line : 169 NORMAN STATION BLVD
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-6396
Country : US
Telephone Number : 704-663-3796
Fax Number : 704-663-4679
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 04/21/2009

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