Healthcare Provider Details

I. General information

NPI: 1861396517
Provider Name (Legal Business Name): ANGELA C WIGET DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 53RD AVE E
BRADENTON FL
34203-4312
US

IV. Provider business mailing address

7142 CHATUM LIGHT RUN
BRADENTON FL
34212-7009
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-0802
  • Fax: 941-752-2084
Mailing address:
  • Phone: 941-752-0802
  • Fax: 941-752-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: