Provider Demographics
NPI:1639359755
Name:COLUMBIA CITY OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:COLUMBIA CITY OPTOMETRY, P.C.
Other - Org Name:ANGELA COTTER, O.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-244-6474
Mailing Address - Street 1:512 N LINE STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1330
Mailing Address - Country:US
Mailing Address - Phone:260-244-6474
Mailing Address - Fax:260-244-6815
Practice Address - Street 1:512 N LINE STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1330
Practice Address - Country:US
Practice Address - Phone:260-244-6474
Practice Address - Fax:260-244-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4634680001Medicare NSC