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NPI Code Detail

MEDICARE: DR. ANGELO JOSEPH DEVIVO OD

MEDICARE: DR. ANGELO JOSEPH DEVIVO OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4531 T1261OH
2152W00000XOptometrist2117SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326040536
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELO JOSEPH DEVIVO OD
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 1774 PAXVILLE HWY
Second Line :
City : MANNING
State : SC
Zip : 29102-5071
Country : US
Telephone Number : 803-435-2494
Fax Number : 803-435-8765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 12/14/2022

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