Provider Demographics
NPI:1518140466
Name:DR AL N ANGLE II & ASSOCIATES OPTOMETRISTS
Entity Type:Organization
Organization Name:DR AL N ANGLE II & ASSOCIATES OPTOMETRISTS
Other - Org Name:DRS SAXON ANGLE & ASSOCIATES P C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANGLE
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:540-483-0284
Mailing Address - Street 1:4024 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-4844
Mailing Address - Country:US
Mailing Address - Phone:434-572-8963
Mailing Address - Fax:
Practice Address - Street 1:4024 HALIFAX RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4844
Practice Address - Country:US
Practice Address - Phone:434-572-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009232001Medicaid
VAC01361Medicare PIN
VAT919-57Medicare UPIN
VA0290020001Medicare NSC