Provider Demographics
NPI:1629074612
Name:AHRENS, ANGELA M (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:AHRENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1716 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7864
Mailing Address - Country:US
Mailing Address - Phone:972-562-0101
Mailing Address - Fax:972-562-0406
Practice Address - Street 1:1716 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7864
Practice Address - Country:US
Practice Address - Phone:972-562-0101
Practice Address - Fax:972-562-0406
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2386152W00000X
TX8576TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200019020BMedicaid
OKCO5028OtherMEDICARE ID
OKP00135879OtherMEDICARE ID
OKTRIADEYEMedicare PIN
OK200019020BMedicaid
OK244414701Medicare ID - Type Unspecified