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General NPI Number Information
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NPI Number | 1366453920
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Entity Type | Organization
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Legal Business Name | ANGELINA OPTOMETRIC ASSOCIATES
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2801 S JOHN REDDITT DR
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City | LUFKIN
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State | TX
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Zip | 75904-5666
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Country | US
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Telephone | 936-637-2020
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Fax | 936-634-4911
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Provider Business Mailing Address
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Address Line | 2801 S JOHN REDDITT DR
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City | LUFKIN
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State | TX
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Zip | 75904-5666
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Country | US
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Telephone | 936-637-2020
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Fax | 936-634-4911
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | DR. ROBERT W ANDERSON JR.
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Credential | OD
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Telephone | 936-637-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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