Provider Demographics
NPI:1184614232
Name:RIVERA, ANGEL L (DO , MS)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DO , MS
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Mailing Address - Street 1:9225 TREASURE OAK CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1649
Mailing Address - Country:US
Mailing Address - Phone:703-339-8852
Mailing Address - Fax:850-878-8900
Practice Address - Street 1:1607 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5352
Practice Address - Country:US
Practice Address - Phone:850-878-0191
Practice Address - Fax:850-878-8900
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR000337152W00000X
DCOP1000120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist