Provider Demographics
NPI:1891825790
Name:NOCHOMSON, ASHLEY S (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:S
Last Name:NOCHOMSON
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 1:10780 OAK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4624
Mailing Address - Country:US
Mailing Address - Phone:954-806-3964
Mailing Address - Fax:
Practice Address - Street 1:2905 N MILITARY TRL STE G
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2921
Practice Address - Country:US
Practice Address - Phone:561-684-5548
Practice Address - Fax:561-684-6229
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001266700Medicaid
FL001266700Medicaid