Provider Demographics
NPI:1245311174
Name:ANGELA HOLDEN OD LLC
Entity type:Organization
Organization Name:ANGELA HOLDEN OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMOTRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-967-1868
Mailing Address - Street 1:1130 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711
Mailing Address - Country:US
Mailing Address - Phone:417-926-7480
Mailing Address - Fax:
Practice Address - Street 1:1433 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483
Practice Address - Country:US
Practice Address - Phone:417-967-1868
Practice Address - Fax:417-967-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty