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General NPI Number Information
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NPI Number | 1134952336
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Entity Type | Individual
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Provider Name | ANGELA MARIE MACKSOUD OD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 375 METACOM AVE
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City | BRISTOL
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State | RI
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Zip | 02809-5179
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Country | US
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Telephone | 401-253-2020
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Fax | 401-253-3220
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Provider Business Mailing Address
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Address Line | 1817 OLD LOUISQUISSET PIKE
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City | LINCOLN
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State | RI
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Zip | 02865-4516
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Country | US
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Telephone | 401-580-3572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODTA00576
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License Number State | RI
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