Provider Demographics
NPI:1801805247
Name:MICHAEL A ANGOTTI
Entity type:Organization
Organization Name:MICHAEL A ANGOTTI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-340-9680
Mailing Address - Street 1:3590 HOLLAND RD
Mailing Address - Street 2:104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4053
Mailing Address - Country:US
Mailing Address - Phone:757-340-9680
Mailing Address - Fax:757-463-5496
Practice Address - Street 1:3590 HOLLAND RD
Practice Address - Street 2:104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4053
Practice Address - Country:US
Practice Address - Phone:757-340-9680
Practice Address - Fax:757-463-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9204181Medicaid
VAT21554Medicare UPIN