Provider Demographics
NPI:1487245676
Name:ERIC NOLL OD PC
Entity type:Organization
Organization Name:ERIC NOLL OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-307-5761
Mailing Address - Street 1:214 W REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6044
Mailing Address - Country:US
Mailing Address - Phone:717-307-5761
Mailing Address - Fax:
Practice Address - Street 1:214 W REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6044
Practice Address - Country:US
Practice Address - Phone:907-486-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty