Provider Demographics
NPI:1265465306
Name:ANGELL, TODD CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CHARLES
Last Name:ANGELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3902
Mailing Address - Country:US
Mailing Address - Phone:702-385-2242
Mailing Address - Fax:702-382-7955
Practice Address - Street 1:1300 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3902
Practice Address - Country:US
Practice Address - Phone:702-385-2242
Practice Address - Fax:702-382-7955
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002502070Medicaid
NVU83797Medicare UPIN
NVV34449Medicare PIN