Provider Demographics
NPI:1134191232
Name:CATES, ANGELA K (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:CATES
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 1:8401 W US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47330
Mailing Address - Country:US
Mailing Address - Phone:765-855-5477
Mailing Address - Fax:
Practice Address - Street 1:100A E WASHINGTON JACKSON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320
Practice Address - Country:US
Practice Address - Phone:937-456-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200542350Medicaid
IN46622OHMedicaid
U94187Medicare UPIN