Healthcare Provider Details

I. General information

NPI: 1417942764
Provider Name (Legal Business Name): ANGELA A ARCHER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GREENWOOD FAMILY EYECARE 710 EXECUTIVE PARK DR STE S1
GREENWOOD IN
46143
US

IV. Provider business mailing address

GREENWOOD FAMILY EYECARE 710 EXECUTIVE PARK DR STE S1
GREENWOOD IN
46143
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-1017
  • Fax: 317-888-8194
Mailing address:
  • Phone: 317-887-1017
  • Fax: 317-888-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003350
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: