Provider Demographics
NPI:1992987473
Name:NATHAN E. NOGA OD PC
Entity type:Organization
Organization Name:NATHAN E. NOGA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOGA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-242-5412
Mailing Address - Street 1:611 24 RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1240
Mailing Address - Country:US
Mailing Address - Phone:970-242-5412
Mailing Address - Fax:970-241-5797
Practice Address - Street 1:611 24 RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1240
Practice Address - Country:US
Practice Address - Phone:970-242-5412
Practice Address - Fax:970-241-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63054Medicare UPIN
COC804520Medicare PIN