Provider Demographics
NPI:1033137195
Name:NOE, ELAINE R (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:NOE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9482
Mailing Address - Country:US
Mailing Address - Phone:330-336-4411
Mailing Address - Fax:
Practice Address - Street 1:1 PARK CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9482
Practice Address - Country:US
Practice Address - Phone:330-335-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS2805156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765266Medicaid
OH0694580001Medicare NSC