Provider Demographics
NPI:1063827228
Name:NOBLE, NATALIA C (OD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:C
Last Name:NOBLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:160 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4706
Practice Address - Country:US
Practice Address - Phone:407-339-0303
Practice Address - Fax:407-339-0961
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9053197-9934152W00000X
FLOPC5064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG189SMedicare PIN
FLIG189TMedicare PIN
FLIG189VMedicare PIN
FLIG189ZMedicare PIN
FLIG189WMedicare PIN
FLIG189QMedicare PIN
FLIG189XMedicare PIN
FLIG189UMedicare PIN
FLIG189PMedicare PIN
FLIG189RMedicare PIN
FLIG189YMedicare PIN