Provider Demographics
NPI:1083740278
Name:NOSKA, NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:NOSKA
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 1:100 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3008
Mailing Address - Country:US
Mailing Address - Phone:979-732-5771
Mailing Address - Fax:
Practice Address - Street 1:100 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3008
Practice Address - Country:US
Practice Address - Phone:979-732-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6608TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216739702Medicaid
TX216739701Medicaid