Basic Information
| Provider Information | |||||||||
| NPI: | 1417942764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | GREENWOOD FAMILY EYECARE | ||||||||
| Address2: | 710 EXECUTIVE PARK DR STE S1 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178871017 | ||||||||
| FaxNumber: | 3178888194 | ||||||||
| Practice Location | |||||||||
| Address1: | GREENWOOD FAMILY EYECARE | ||||||||
| Address2: | 710 EXECUTIVE PARK DR STE S1 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178871017 | ||||||||
| FaxNumber: | 3178888194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18003350 | IN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | NA | 01 | IN | VISION SERVICE PLAN | OTHER | NA | 01 | IN | PRIVATE HEALTHCARE SYSTEM | OTHER | PENDING | 01 | IN | EYEMED VISION CARE | OTHER | PENDING | 01 | IN | ANTHEM BCBS | OTHER | PENDING | 01 | IN | AETNA USHC | OTHER |