Provider Demographics
NPI:1073588703
Name:BEVELS, ANGELA GERMAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GERMAINE
Last Name:BEVELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3402 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5406
Mailing Address - Country:US
Mailing Address - Phone:520-355-2060
Mailing Address - Fax:
Practice Address - Street 1:3402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5406
Practice Address - Country:US
Practice Address - Phone:203-552-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0905680OtherBCBS OF AZ
AZ29839OtherAVESIS
AZ2Z2034OtherHEALTH NET
AZAZ0905680OtherBCBS OF AZ
AZ2Z2034OtherHEALTH NET