Provider Demographics
NPI:1689090102
Name:NOBLE, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:NOBLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2505 S 38TH ST STE A108
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7372
Mailing Address - Country:US
Mailing Address - Phone:253-472-1188
Mailing Address - Fax:253-472-3594
Practice Address - Street 1:2505 S 38TH ST STE A108
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7372
Practice Address - Country:US
Practice Address - Phone:253-472-1188
Practice Address - Fax:253-472-3594
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002303152W00000X
WA60684020152W00000X
CA33364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist