Provider Demographics
NPI:1205921434
Name:HOLDEN, ANGELA JO (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JO
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:JO
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711
Mailing Address - Country:US
Mailing Address - Phone:417-926-7480
Mailing Address - Fax:
Practice Address - Street 1:1433 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483
Practice Address - Country:US
Practice Address - Phone:417-967-1868
Practice Address - Fax:417-967-1870
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist