Provider Demographics
NPI:1194793083
Name:FERGUSON, ANGELA DEE (OD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEE
Last Name:FERGUSON
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:PO BOX 1138
Mailing Address - Street 2:22 W MAIN ST
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-529-2020
Mailing Address - Fax:509-529-2115
Practice Address - Street 1:22 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-529-2020
Practice Address - Fax:509-529-2115
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3572TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022886005OtherREGENCE OREGON
140327OtherDEPT OF LABOR AND INDUSTR
257622800OtherGROUP HEALTH
410045308OtherTRAVELERS MEDICARE
U82129OtherVISION SERVICE PLAN
WA8886644808OtherCOMMUNITY HEALTH PLAN
032340000OtherCIGNA
0323400001OtherMC SUPPLY CIGNA DMERC
WA2023836Medicaid
410045308OtherUPPR
7753255OtherAETNA
WA3044FEOtherREGENCE WASHINGTON
610605300OtherDEPT OF LABOR SEATTLEDFEC
257622800OtherGROUP HEALTH
WAGAB17497Medicare ID - Type Unspecified