Provider Demographics
NPI:1790916856
Name:BERGIN, ANGELA D, (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:D,
Last Name:BERGIN
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 1:14154 STEELE CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4376
Mailing Address - Country:US
Mailing Address - Phone:980-319-1870
Mailing Address - Fax:704-541-8379
Practice Address - Street 1:14154 STEELE CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4376
Practice Address - Country:US
Practice Address - Phone:980-319-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist