Provider Demographics
NPI:1639181480
Name:NOGA, NATHAN E (OD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:NOGA
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 1:611 24 RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1240
Mailing Address - Country:US
Mailing Address - Phone:970-242-5412
Mailing Address - Fax:970-241-5797
Practice Address - Street 1:611 24 RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1240
Practice Address - Country:US
Practice Address - Phone:970-242-5412
Practice Address - Fax:970-241-5797
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63054Medicare UPIN
804521Medicare ID - Type Unspecified