Provider Demographics
NPI:1376600239
Name:NOCELLA, DAWN L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:L
Last Name:NOCELLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1816
Mailing Address - Country:US
Mailing Address - Phone:856-318-1062
Mailing Address - Fax:
Practice Address - Street 1:38 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1816
Practice Address - Country:US
Practice Address - Phone:856-318-1062
Practice Address - Fax:856-318-1069
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA005738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU87812Medicare UPIN
NJ052894AN4Medicare PIN
NJ235084Medicare PIN