Provider Demographics
NPI:1225088503
Name:NOONAN, DAVID M (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:NOONAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:18419 DEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7819
Mailing Address - Country:US
Mailing Address - Phone:704-892-3817
Mailing Address - Fax:
Practice Address - Street 1:169 NORMAN STATION BLVD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6396
Practice Address - Country:US
Practice Address - Phone:704-663-3796
Practice Address - Fax:704-663-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNOONAN DAVID M 10028OtherOPTICARE
NC093G0OtherBCBS
NCNVAL28224OtherSPECTERA
NCU60499Medicare UPIN
NC093G0OtherBCBS