Provider Demographics
NPI:1801120043
Name:DORECK, ANGELA GAMBLE (OD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GAMBLE
Last Name:DORECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6704 STERLING RIDGE DR STE D
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2329
Mailing Address - Country:US
Mailing Address - Phone:281-465-8300
Mailing Address - Fax:281-465-8303
Practice Address - Street 1:6704 STERLING RIDGE DR STE D
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2329
Practice Address - Country:US
Practice Address - Phone:281-465-8300
Practice Address - Fax:281-465-8303
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7372TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist