Provider Demographics
NPI:1417942764
Name:ARCHER, ANGELA A (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:ARCHER
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:GREENWOOD FAMILY EYECARE
Mailing Address - Street 2:710 EXECUTIVE PARK DR STE S1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:317-887-1017
Mailing Address - Fax:317-888-8194
Practice Address - Street 1:GREENWOOD FAMILY EYECARE
Practice Address - Street 2:710 EXECUTIVE PARK DR STE S1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-887-1017
Practice Address - Fax:317-888-8194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNAOtherVISION SERVICE PLAN
INNAOtherPRIVATE HEALTHCARE SYSTEM
INPENDINGOtherEYEMED VISION CARE
INPENDINGOtherANTHEM BCBS
INPENDINGOtherAETNA USHC
INPENDINGOtherEYEMED VISION CARE
INNAOtherVISION SERVICE PLAN