Provider Demographics
NPI:1861400202
Name:ANGOTTI, MICHAEL A (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:ANGOTTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VOLVO PKWY
Mailing Address - Street 2:#9
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4609
Mailing Address - Country:US
Mailing Address - Phone:757-498-0695
Mailing Address - Fax:
Practice Address - Street 1:109 VOLVO PKWY
Practice Address - Street 2:#9
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4609
Practice Address - Country:US
Practice Address - Phone:757-498-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9204181Medicaid
VA9204181Medicaid