Provider Demographics
NPI:1194130286
Name:NOEGEL, ASHLEY (OD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NOEGEL
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 1:52 TUSCAN WAY STE 202-103
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1850
Mailing Address - Country:US
Mailing Address - Phone:904-547-2691
Mailing Address - Fax:
Practice Address - Street 1:124 TUSCAN WAY STE 104
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1851
Practice Address - Country:US
Practice Address - Phone:904-547-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4914152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist