Provider Demographics
NPI:1326284530
Name:WIARDA, NOAH COLE (OD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:COLE
Last Name:WIARDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4786 MCMURRY AVE UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4499
Mailing Address - Country:US
Mailing Address - Phone:970-204-4020
Mailing Address - Fax:970-658-5830
Practice Address - Street 1:4786 MCMURRY AVE UNIT 2A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4499
Practice Address - Country:US
Practice Address - Phone:970-204-4020
Practice Address - Fax:970-658-5830
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45836868Medicaid