Provider Demographics
NPI:1952399164
Name:WHATTS, ANGEL (OD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:WHATTS
Suffix:
Gender:M
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:J12 CALLE ELLIOT VELEZ
Mailing Address - Street 2:ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4616
Mailing Address - Country:US
Mailing Address - Phone:787-854-1551
Mailing Address - Fax:787-884-3984
Practice Address - Street 1:J12 CALLE ELLIOT VELEZ
Practice Address - Street 2:ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-1551
Practice Address - Fax:787-884-3984
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0297930001OtherPALMETTO GBA REGION C
T26865Medicare UPIN
SC0297930001OtherPALMETTO GBA REGION C