Provider Demographics
NPI:1386697266
Name:NOBLE, MICHAEL C (OPTOMETRIC DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:NOBLE
Suffix:
Gender:M
Credentials:OPTOMETRIC DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3961
Mailing Address - Country:US
Mailing Address - Phone:509-966-2966
Mailing Address - Fax:509-966-3230
Practice Address - Street 1:1211 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3961
Practice Address - Country:US
Practice Address - Phone:509-966-2966
Practice Address - Fax:509-966-3230
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001563152W00000X
OR1651D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANO1023OtherREGENCE BLUE SHIELD
WA2015485Medicaid
WAT02111Medicare UPIN
WA2015485Medicaid
WA1386697266Medicare NSC
WANO1023OtherREGENCE BLUE SHIELD
WA1386697266Medicare PIN
WA1295860001Medicare NSC