Provider Demographics
NPI:1518082635
Name:NOLAN, MAUREEN P (OD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:P
Last Name:NOLAN
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 1:65 JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4709
Mailing Address - Country:US
Mailing Address - Phone:631-582-3226
Mailing Address - Fax:
Practice Address - Street 1:5507 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2031
Practice Address - Country:US
Practice Address - Phone:631-474-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005594-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1851467955OtherNPI