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NPI Code Detail

MEDICARE: DR. DANA MARIE NOLAN OD

MEDICARE: DR. DANA MARIE NOLAN 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
1152W00000XOptometristOPC003292FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12203753OTHERUNITED HEALTHCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
37524090OTHERFLAETNA
420856OTHERFLBLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number : 1942296983
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANA MARIE NOLAN OD
Provider Business Mailing Address
First Line : 3588 SAINT JOHNS AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32205-8446
Country : US
Telephone Number : 904-388-7767
Fax Number : 904-388-0067
Provider Business Practice Location Address
First Line : 3588 SAINT JOHNS AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32205-8446
Country : US
Telephone Number : 904-388-7767
Fax Number : 904-388-0067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 09/24/2012

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