Provider Demographics
NPI:1184804841
Name:ROSE, ANGELA FINLEY (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:FINLEY
Last Name:ROSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:FINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:203 FAWN ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4928
Mailing Address - Country:US
Mailing Address - Phone:501-318-6177
Mailing Address - Fax:
Practice Address - Street 1:1635 HIGDON FERRY RD
Practice Address - Street 2:SUITE E
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-525-4272
Practice Address - Fax:501-525-4297
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1246152W00000X
AR2387152WV0400X
WA3107152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178314722Medicaid
AR178314722Medicaid