Provider Demographics
NPI:1689430472
Name:TREACY, ANGELA BRITTANY
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BRITTANY
Last Name:TREACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7318
Mailing Address - Country:US
Mailing Address - Phone:757-498-1503
Mailing Address - Fax:757-498-2814
Practice Address - Street 1:657 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7318
Practice Address - Country:US
Practice Address - Phone:757-498-1503
Practice Address - Fax:757-498-2814
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004453156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician