Basic Information
| Provider Information | |||||||||
| NPI: | 1891825790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOCHOMSON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10780 OAK MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334494624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548063964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2905 N MILITARY TRL STE G | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334092921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616845548 | ||||||||
| FaxNumber: | 5616846229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 4044 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 001266700 | 05 | FL | MEDICAID |