Provider Demographics
NPI:1003188053
Name:ANGELO EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ANGELO EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-642-7600
Mailing Address - Street 1:813 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1238
Mailing Address - Country:US
Mailing Address - Phone:856-642-7600
Mailing Address - Fax:856-608-0501
Practice Address - Street 1:813 E GATE DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1238
Practice Address - Country:US
Practice Address - Phone:856-642-7600
Practice Address - Fax:856-608-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ234449OtherMEDICARE
NJ234449OtherMEDICARE