Provider Demographics
NPI:1922141688
Name:NOLTON, CAMILLE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:NOLTON
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 1:7171 N DAVIS HWY
Mailing Address - Street 2:STE 1059
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6254
Mailing Address - Country:US
Mailing Address - Phone:850-471-1186
Mailing Address - Fax:850-471-9230
Practice Address - Street 1:7171 N DAVIS HWY
Practice Address - Street 2:STE 1059
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6254
Practice Address - Country:US
Practice Address - Phone:850-471-1186
Practice Address - Fax:850-471-9230
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU74264Medicare UPIN