Provider Demographics
NPI:1780858464
Name:J DEAN NOLAN OD INC
Entity Type:Organization
Organization Name:J DEAN NOLAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-353-2015
Mailing Address - Street 1:3414 NW CACHE RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3877
Mailing Address - Country:US
Mailing Address - Phone:580-353-2015
Mailing Address - Fax:580-353-2022
Practice Address - Street 1:3414 NW CACHE RD STE E
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3877
Practice Address - Country:US
Practice Address - Phone:580-353-2015
Practice Address - Fax:580-353-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1558379669OtherTRICARE
OK100765020AMedicaid
OKB5156OtherMEDICARE PTAN