Provider Demographics
NPI:1134952336
Name:MACKSOUD, ANGELA MARIE (OD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MACKSOUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 OLD LOUISQUISSET PIKE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4516
Mailing Address - Country:US
Mailing Address - Phone:401-580-3572
Mailing Address - Fax:
Practice Address - Street 1:375 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5179
Practice Address - Country:US
Practice Address - Phone:401-253-2020
Practice Address - Fax:401-253-3220
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist