Provider Demographics
NPI:1558552430
Name:BREEDING, ANGELA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ANN
Last Name:BREEDING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0490
Mailing Address - Country:US
Mailing Address - Phone:918-647-2153
Mailing Address - Fax:918-647-8711
Practice Address - Street 1:1230 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5266
Practice Address - Country:US
Practice Address - Phone:918-647-2153
Practice Address - Fax:918-647-8711
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200128380AMedicaid
OK245732001Medicare PIN