MEDICARE: ANGELA DANTIN 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	152WC0802X	Corneal and Contact Management Optometrist	8942T	TX
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	8942T	TX
3	152W00000X	Optometrist	8942T	TX

General Provider Information

NPI Number	:	1942651104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DANTIN O.D.

Provider Business Mailing Address
First Line	:	515 22ND ST
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77550-1922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 25TH AVE N STE 3
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-4666
Country	:	US
Telephone Number	:	409-945-5511
Fax Number	:	409-945-5511

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	02/10/2025

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