Provider Demographics
NPI:1760691208
Name:PITTS, ANGELA RUTH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RUTH
Last Name:PITTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:PITTS
Other - Last Name:AUGUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:149 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8804
Mailing Address - Country:US
Mailing Address - Phone:813-514-7707
Mailing Address - Fax:
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:SUITE 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-538-1220
Practice Address - Fax:202-574-1674
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCOP 1000184OtherOPTOMETRY LISCENSE