Provider Demographics
NPI:1730139221
Name:HASE, ANGELA J (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:HASE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5026
Mailing Address - Country:US
Mailing Address - Phone:605-225-4046
Mailing Address - Fax:605-225-9728
Practice Address - Street 1:1715 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5026
Practice Address - Country:US
Practice Address - Phone:605-225-4046
Practice Address - Fax:605-225-9728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist