Provider Demographics
NPI:1548617236
Name:NOLAN, CHELSEA NOELLE (LDO)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NOELLE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4557
Mailing Address - Country:US
Mailing Address - Phone:954-973-2150
Mailing Address - Fax:
Practice Address - Street 1:258 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4557
Practice Address - Country:US
Practice Address - Phone:954-973-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6413156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician