Provider Demographics
NPI:1437431616
Name:GIANNOBILE, ANGELA RENEE (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:GIANNOBILE
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 1:955 W EISENHOWER CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5868
Mailing Address - Country:US
Mailing Address - Phone:734-332-8840
Mailing Address - Fax:734-332-8841
Practice Address - Street 1:955 W EISENHOWER CIR
Practice Address - Street 2:SUITE F
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5868
Practice Address - Country:US
Practice Address - Phone:734-332-8840
Practice Address - Fax:734-332-8841
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist