MEDICARE: ANGELA MARIE CHANGO-HOLT O.D.

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
1	152W00000X	Optometrist	OEG000218	PA

General Provider Information

NPI Number	:	1306919097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE CHANGO-HOLT O.D.

Provider Business Mailing Address
First Line	:	2548 RALEIGH RD
Second Line	:
City	:	HUMMELSTOWN
State	:	PA
Zip	:	17036-7079
Country	:	US
Telephone Number	:	717-657-7792
Fax Number	:	717-657-1423

Provider Business Practice Location Address
First Line	:	ROUTE 22 & COLONIAL ROAD
Second Line	:	COLONIAL PARK MALL
City	:	HARRISBURG
State	:	PA
Zip	:	17109-6234
Country	:	US
Telephone Number	:	717-657-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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