Provider Demographics
NPI:1811005028
Name:NICOLINI, ANGELA ELISE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ELISE
Last Name:NICOLINI
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 1:3225 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6221
Mailing Address - Country:US
Mailing Address - Phone:325-691-0101
Mailing Address - Fax:325-691-8950
Practice Address - Street 1:3225 S 27TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6221
Practice Address - Country:US
Practice Address - Phone:325-691-0101
Practice Address - Fax:325-691-8950
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04853TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A002OtherHUMANA/TRICARE
TX81010QOtherBLUE CROSS BLUE SHIELD
04060Medicare UPIN
TX8C0208Medicare ID - Type Unspecified