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NPI Code Detail

MEDICARE: DR. MICHAEL J NODLAND O.D.

MEDICARE: DR. MICHAEL J NODLAND O.D.
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
1152W00000XOptometristOPC 4365FL

General Provider Information

NPI Number : 1639328750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL J NODLAND O.D.
Provider Business Mailing Address
First Line : 1601 S FLAGLER DR
Second Line : 1030
City : WEST PALM BEACH
State : FL
Zip : 33401-7154
Country : US
Telephone Number : 561-784-2778
Fax Number : 561-798-9409
Provider Business Practice Location Address
First Line : 10155 OKEECHOBEE BLVD
Second Line : OPTICAL
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1404
Country : US
Telephone Number : 561-784-2778
Fax Number : 561-798-9409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2008
Last Update Date : 12/13/2010

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