Provider Demographics
NPI:1366154494
Name:NOLASCO, RUBEN MATHEW
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:MATHEW
Last Name:NOLASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 FEDERAL BLVD UNIT 500
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-8617
Mailing Address - Country:US
Mailing Address - Phone:720-831-9234
Mailing Address - Fax:
Practice Address - Street 1:10350 FEDERAL BLVD UNIT 500
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-8617
Practice Address - Country:US
Practice Address - Phone:720-831-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician