Provider Demographics
NPI:1801908546
Name:PRINCE, ANGELA DOWDY (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DOWDY
Last Name:PRINCE
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 1:540 MOUNT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-8618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4037
Practice Address - Country:US
Practice Address - Phone:205-302-0020
Practice Address - Fax:205-387-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS841TA374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525032OtherBLUE CROSS AND BLUE SHIEL
LA1637815OtherMEDICAID
AL926295OtherBLOCK VISION
U78975Medicare UPIN