Provider Demographics
NPI:1902427511
Name:VASQUEZ, ANGELIQUE (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:
Last Name:VASQUEZ
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 1:143 45TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3007
Mailing Address - Country:US
Mailing Address - Phone:503-799-1964
Mailing Address - Fax:
Practice Address - Street 1:1000 ROSS PARK MALL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3875
Practice Address - Country:US
Practice Address - Phone:412-537-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist