Provider Demographics
NPI:1326498718
Name:NOBLES, JOHNNIE RAY JR (OD)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:RAY
Last Name:NOBLES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5551
Mailing Address - Country:US
Mailing Address - Phone:256-547-2025
Mailing Address - Fax:256-547-2019
Practice Address - Street 1:2015 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5551
Practice Address - Country:US
Practice Address - Phone:256-547-2025
Practice Address - Fax:256-547-2019
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D55152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist