MEDICARE: CHERYL ANN ANGELO 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	4699	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588734677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ANN ANGELO O.D.

Provider Business Mailing Address
First Line	:	813 E GATE DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1238
Country	:	US
Telephone Number	:	856-642-7600
Fax Number	:	856-608-0501

Provider Business Practice Location Address
First Line	:	813 E GATE DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1238
Country	:	US
Telephone Number	:	856-642-7600
Fax Number	:	856-608-0501

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

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

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