Provider Demographics
NPI:1316639289
Name:NADOLNY, THOMAS EUGENE
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EUGENE
Last Name:NADOLNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4887
Mailing Address - Country:US
Mailing Address - Phone:352-596-1045
Mailing Address - Fax:352-596-0913
Practice Address - Street 1:13360 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4887
Practice Address - Country:US
Practice Address - Phone:352-596-1045
Practice Address - Fax:352-596-0913
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5360156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician