Provider Demographics
NPI:1366881716
Name:NOBLEOD LLC
Entity type:Organization
Organization Name:NOBLEOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:DEXTER
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:770-815-8629
Mailing Address - Street 1:4850 GOLDEN PKWY STE. B #175
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5842
Mailing Address - Country:US
Mailing Address - Phone:770-815-8629
Mailing Address - Fax:
Practice Address - Street 1:4850 GOLDEN PKWY STE. B #175
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5842
Practice Address - Country:US
Practice Address - Phone:770-815-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT0012119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty