Provider Demographics
NPI:1083963482
Name:NOBLE, ANDREW GLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GLEN
Last Name:NOBLE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:20669 BOND RD NE
Mailing Address - Street 2:STE 100
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6525
Mailing Address - Country:US
Mailing Address - Phone:360-626-5220
Mailing Address - Fax:360-779-3093
Practice Address - Street 1:20669 BOND RD NE
Practice Address - Street 2:STE 100
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6525
Practice Address - Country:US
Practice Address - Phone:360-626-5220
Practice Address - Fax:360-779-3093
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOD60299410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist