Provider Demographics
NPI:1548485535
Name:PEI, ANGIE R (OD)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:R
Last Name:PEI
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 1:810 S LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-5309
Mailing Address - Country:US
Mailing Address - Phone:813-494-1436
Mailing Address - Fax:
Practice Address - Street 1:5135 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3505
Practice Address - Country:US
Practice Address - Phone:813-902-1710
Practice Address - Fax:813-805-7901
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU29190Medicare UPIN
FL20780Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER