Provider Demographics
NPI:1750652020
Name:ANGIE R. PEI, O.D., P.A.
Entity Type:Organization
Organization Name:ANGIE R. PEI, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-494-1436
Mailing Address - Street 1:5135 S DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3505
Mailing Address - Country:US
Mailing Address - Phone:813-902-1710
Mailing Address - Fax:813-805-7901
Practice Address - Street 1:5135 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3505
Practice Address - Country:US
Practice Address - Phone:813-902-1710
Practice Address - Fax:813-805-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty