Provider Demographics
NPI:1639126600
Name:NOBLE, JONATHAN RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:NOBLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1441
Mailing Address - Country:US
Mailing Address - Phone:804-290-4278
Mailing Address - Fax:804-217-6400
Practice Address - Street 1:3855 GASKINS RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1441
Practice Address - Country:US
Practice Address - Phone:804-290-4278
Practice Address - Fax:804-217-6400
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266832OtherANTHEM
VA171918OtherANTHEM
VA010259673Medicaid
VA171918OtherANTHEM