Provider Demographics
NPI:1033275102
Name:COTTER, ANGELA E (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:E
Last Name:COTTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:E
Other - Last Name:LEONHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:512 N LINE STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1330
Mailing Address - Country:US
Mailing Address - Phone:260-244-6474
Mailing Address - Fax:260-244-6815
Practice Address - Street 1:512 N LINE STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1330
Practice Address - Country:US
Practice Address - Phone:260-244-6474
Practice Address - Fax:260-244-6815
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN320000963OtherVSP
IN4634680001OtherDMERC
ININ2686OtherANTHEM BLUE VISION
ININ2686OtherEYEMED
ININ2686OtherANTHEM BLUE VISION
ININ2686OtherEYEMED