Provider Demographics
NPI:1417089343
Name:EDWIN N ANGUAS, O.D. P.A.
Entity Type:Organization
Organization Name:EDWIN N ANGUAS, O.D. P.A.
Other - Org Name:VALU-VISION OF ORANGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:ANGUAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-264-5483
Mailing Address - Street 1:28 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2202
Mailing Address - Country:US
Mailing Address - Phone:904-264-5483
Mailing Address - Fax:904-213-0515
Practice Address - Street 1:28 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2202
Practice Address - Country:US
Practice Address - Phone:904-264-5483
Practice Address - Fax:904-213-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC000907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84031Medicare UPIN
FL19043Medicare ID - Type Unspecified