Provider Demographics
NPI:1942296983
Name:NOLAN, DANA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:NOLAN
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 1:3588 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8446
Mailing Address - Country:US
Mailing Address - Phone:904-388-7767
Mailing Address - Fax:904-388-0067
Practice Address - Street 1:3588 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8446
Practice Address - Country:US
Practice Address - Phone:904-388-7767
Practice Address - Fax:904-388-0067
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2203753OtherUNITED HEALTHCARE
FL620382500Medicaid
FL7524090OtherAETNA
FL20856OtherBLUE CROSS BLUE SHIELD FL
FL20856ZMedicare PIN
FL0853060001Medicare NSC
FL410049535Medicare PIN
FL7524090OtherAETNA