MEDICARE: DR AL N ANGLE II & ASSOCIATES

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	0618000552	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB0861	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	025247	OTHER	VA	ANTHEM BC BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952464315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR AL N ANGLE II & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:	395 S MAIN ST
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1710
Country	:	US
Telephone Number	:	540-483-0284
Fax Number	:	540-483-9680

Provider Business Practice Location Address
First Line	:	395 S MAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1710
Country	:	US
Telephone Number	:	540-483-0284
Fax Number	:	540-483-9680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AL N ANGLE II
Credential	:	OD
Telephone Number	:	540-483-0284

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	12/19/2011

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