Provider Demographics
NPI:1992704365
Name:J. A. NOLAN, OD LTD
Entity type:Organization
Organization Name:J. A. NOLAN, OD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-422-7000
Mailing Address - Street 1:11412 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2004
Mailing Address - Country:US
Mailing Address - Phone:708-422-7000
Mailing Address - Fax:708-448-4295
Practice Address - Street 1:11412 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2004
Practice Address - Country:US
Practice Address - Phone:708-422-7000
Practice Address - Fax:708-448-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0467216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL659820Medicare ID - Type Unspecified
T36629Medicare UPIN