Provider Demographics
NPI:1972614170
Name:JONATHAN R NOBLE OD AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:JONATHAN R NOBLE OD AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-752-0188
Mailing Address - Street 1:145 HILL CARTER PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2327
Mailing Address - Country:US
Mailing Address - Phone:804-752-0188
Mailing Address - Fax:804-752-0187
Practice Address - Street 1:145 HILL CARTER PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2327
Practice Address - Country:US
Practice Address - Phone:804-752-0188
Practice Address - Fax:804-752-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09476Medicare ID - Type UnspecifiedGROUP NUMBER