Provider Demographics
NPI:1629493408
Name:NOONAN, PATRICIA (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:NOONAN
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 1:12910 STATE ROUTE 664 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8564
Mailing Address - Country:US
Mailing Address - Phone:740-380-1939
Mailing Address - Fax:740-380-6410
Practice Address - Street 1:12910 STATE ROUTE 664 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8564
Practice Address - Country:US
Practice Address - Phone:740-380-1939
Practice Address - Fax:740-380-6410
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist