Provider Demographics
NPI:1932264744
Name:NOLTE, JULIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:NOLTE
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 1:77 S. GIRL SCHOOL RD.
Mailing Address - Street 2:103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231
Mailing Address - Country:US
Mailing Address - Phone:317-486-9427
Mailing Address - Fax:317-486-9429
Practice Address - Street 1:77 S. GIRL SCHOOL RD.
Practice Address - Street 2:103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231
Practice Address - Country:US
Practice Address - Phone:317-486-9427
Practice Address - Fax:317-486-9429
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200425630Medicaid
INDU2921Medicare PIN
INU65296Medicare UPIN
IN183200Medicare ID - Type Unspecified
IN1229900001Medicare NSC