Provider Demographics
NPI:1215229273
Name:COLASURDO NOLAN, NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:COLASURDO NOLAN
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 1:185 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1219
Mailing Address - Country:US
Mailing Address - Phone:860-296-1700
Mailing Address - Fax:860-296-8341
Practice Address - Street 1:185 SILAS DEANE HWY STE 1
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1219
Practice Address - Country:US
Practice Address - Phone:860-296-1700
Practice Address - Fax:860-296-8341
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty