Provider Demographics
NPI:1407833536
Name:SANTINGA, ANGELA GAIL (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GAIL
Last Name:SANTINGA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1924
Mailing Address - Country:US
Mailing Address - Phone:540-371-2020
Mailing Address - Fax:540-373-0141
Practice Address - Street 1:110 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1924
Practice Address - Country:US
Practice Address - Phone:540-371-2020
Practice Address - Fax:540-373-0141
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66970Medicare UPIN