Provider Demographics
NPI:1932179942
Name:HOWELL, ANGELA CAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CAROL
Last Name:HOWELL
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 1:3708 ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-9706
Mailing Address - Country:US
Mailing Address - Phone:870-598-4002
Mailing Address - Fax:
Practice Address - Street 1:2100 E HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5383
Practice Address - Country:US
Practice Address - Phone:870-336-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT003012152W00000X
TN2863152W00000X
AR2384152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312904709Medicaid
MO312904717Medicaid
AR5G858OtherMEDICARE PTAN
AR140020722Medicaid
MO312901725Medicaid
AR118130722Medicaid
LA1635570Medicaid
TN2863OtherOD
410037446OtherRAILROAD MEDICARE PTAN
LA1635570Medicaid
MO312904717Medicaid
TN2863OtherOD
LA1635570Medicaid
0152410001Medicare NSC
MO000000604Medicare PIN