Provider Demographics
NPI:1477884930
Name:ANGELA DARVEAUX, OD, PC
Entity Type:Organization
Organization Name:ANGELA DARVEAUX, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARVEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-277-3636
Mailing Address - Street 1:3902 13TH AVE S
Mailing Address - Street 2:256
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:256
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-277-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty