Provider Demographics
NPI:1356032205
Name:ECHIVERRI, ANGELICA A (OD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:A
Last Name:ECHIVERRI
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 1:7865 S BINGHAM JUNCTION BLVD UNIT D417
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4977
Mailing Address - Country:US
Mailing Address - Phone:214-517-5865
Mailing Address - Fax:
Practice Address - Street 1:122 E 1700 S BLDG 3
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5644
Practice Address - Country:US
Practice Address - Phone:385-248-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6261152W00000X
UT14111771-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist