Provider Demographics
NPI:1770763997
Name:ANGEL WEAR LLC
Entity type:Organization
Organization Name:ANGEL WEAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASI
Authorized Official - Suffix:
Authorized Official - Credentials:LPED
Authorized Official - Phone:352-624-4335
Mailing Address - Street 1:11100 SW 93RD COURT RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-5187
Mailing Address - Country:US
Mailing Address - Phone:352-624-4335
Mailing Address - Fax:352-624-4330
Practice Address - Street 1:11100 SW 93RD COURT RD
Practice Address - Street 2:SUITE #7
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-5187
Practice Address - Country:US
Practice Address - Phone:352-624-4335
Practice Address - Fax:352-624-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCPED2747335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6041030001Medicare NSC