Provider Demographics
NPI:1710120415
Name:NOLASCO, CHELSEY BREANNE (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:BREANNE
Last Name:NOLASCO
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 1:6110 MARTINEZ ST
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-2048
Mailing Address - Country:US
Mailing Address - Phone:719-368-2446
Mailing Address - Fax:719-576-9332
Practice Address - Street 1:6110 MARTINEZ ST
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-2048
Practice Address - Country:US
Practice Address - Phone:719-368-2446
Practice Address - Fax:719-576-9332
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15180152W00000X
CO2874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist