Provider Demographics
NPI:1114288313
Name:ROSE, LAURA NOLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:NOLAN
Last Name:ROSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:302 W 14TH ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-590-6157
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:302 W 14TH ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-590-6157
Practice Address - Fax:812-284-3822
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003723A152W00000X
KY1883DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist