Provider Demographics
NPI:1861621112
Name:TEKIPPE, ANGELA RAYE (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RAYE
Last Name:TEKIPPE
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 1:3800 MERLE HAY RD
Mailing Address - Street 2:SUITE 906
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1305
Mailing Address - Country:US
Mailing Address - Phone:515-278-2368
Mailing Address - Fax:515-278-2955
Practice Address - Street 1:3800 MERLE HAY RD
Practice Address - Street 2:SUITE 906
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1305
Practice Address - Country:US
Practice Address - Phone:515-278-2368
Practice Address - Fax:515-278-2955
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist