Provider Demographics
NPI:1780987313
Name:ANGELA LOEB, OD, PLLC
Entity type:Organization
Organization Name:ANGELA LOEB, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-606-1442
Mailing Address - Street 1:625 BLACK LAKE BLVD SW
Mailing Address - Street 2:SUITE 369
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5066
Mailing Address - Country:US
Mailing Address - Phone:360-753-4533
Mailing Address - Fax:
Practice Address - Street 1:625 BLACK LAKE BLVD SW
Practice Address - Street 2:SUITE 369
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5066
Practice Address - Country:US
Practice Address - Phone:360-753-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60164642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty