Provider Demographics
NPI:1295142834
Name:NOLL, AIMEE LYNN (OD)
Entity type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:LYNN
Last Name:NOLL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2645 SAINT ROSE PKWY STE C-110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4886
Mailing Address - Country:US
Mailing Address - Phone:702-665-4960
Mailing Address - Fax:702-665-6338
Practice Address - Street 1:2645 SAINT ROSE PKWY STE C-110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4886
Practice Address - Country:US
Practice Address - Phone:702-665-4960
Practice Address - Fax:702-665-6338
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV850152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
CA15055152WC0802X, 152WL0500X, 152WP0200X, 152WX0102X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy