Provider Demographics
NPI:1821200973
Name:COATES, ANGELA DEE (OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEE
Last Name:COATES
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770965
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33077-0965
Mailing Address - Country:US
Mailing Address - Phone:954-345-7812
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 89TH DR
Practice Address - Street 2:#2520
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-345-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2342 FL OPC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19246Medicare UPIN