Provider Demographics
NPI:1487710661
Name:ANGELO, STEPHEN JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:ANGELO
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 1:154 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3400
Mailing Address - Country:US
Mailing Address - Phone:978-794-9500
Mailing Address - Fax:978-794-9504
Practice Address - Street 1:154 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3400
Practice Address - Country:US
Practice Address - Phone:978-794-9500
Practice Address - Fax:978-794-9504
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19174OtherSPECTERA
MA4521413OtherCIGNA
MAMA03728OtherVISION BENEFITS AMERICA
MA67647OtherFALLON COMMUNITY HEALTH
MA981027OtherNETWORK HEALTH
MA22-00425OtherUNITED HEALTH CARE
MA408090OtherTUFTS HEALTH
MAMA3728OtherEYEMED
MA0024381OtherNEIGHBORHOOD HEALTH
MA0391808Medicaid
MA152622OtherHARVARD PILGRIM
MAW15923OtherBCBS
MA0391808Medicaid
MAANW17304Medicare Oscar/Certification
MAANW17304Medicare PIN