Provider Demographics
NPI:1447414040
Name:APPLEMAN, ANGELA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:APPLEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:VANDYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:STE 240 A
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2982
Practice Address - Country:US
Practice Address - Phone:573-458-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015012017152W00000X
GAOPT002473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicare PIN