Provider Demographics
NPI:1073795357
Name:DR JAMES R NOLAN DR RONALD R NOLAN INC
Entity Type:Organization
Organization Name:DR JAMES R NOLAN DR RONALD R NOLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-944-6428
Mailing Address - Street 1:1819 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4994
Mailing Address - Country:US
Mailing Address - Phone:812-944-6428
Mailing Address - Fax:812-945-7240
Practice Address - Street 1:1819 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4994
Practice Address - Country:US
Practice Address - Phone:812-944-6428
Practice Address - Fax:812-945-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001610A152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100153350AMedicaid
IN438480Medicare PIN
IN100153350AMedicaid