Provider Demographics
NPI:1952464315
Name:DR AL N ANGLE II & ASSOCIATES
Entity Type:Organization
Organization Name:DR AL N ANGLE II & ASSOCIATES
Other - Org Name:ANGLE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANGLE
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:540-483-0284
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:395 S MAIN ST
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1710
Mailing Address - Country:US
Mailing Address - Phone:540-483-0284
Mailing Address - Fax:540-483-9680
Practice Address - Street 1:395 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1710
Practice Address - Country:US
Practice Address - Phone:540-483-0284
Practice Address - Fax:540-483-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB0861OtherRAILROAD MEDICARE
VA025247OtherANTHEM BC BS
VA009206990Medicaid
VA009206990Medicaid
VA0290020003Medicare NSC
VAC01363Medicare ID - Type Unspecified