Provider Demographics
NPI:1568158384
Name:NOLAN, LEONARDO DOCK JR
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:DOCK
Last Name:NOLAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334664 SCHOEHERR RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312
Mailing Address - Country:US
Mailing Address - Phone:313-208-4782
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:334664 SCHOEHERR RD
Practice Address - Street 2:SUITE 180
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312
Practice Address - Country:US
Practice Address - Phone:313-208-4782
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIN450507149775156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist