Individual
DR. ANGELO JOSEPH DEVIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1774 PAXVILLE HWY, MANNING, SC 29102-5071
(803) 435-2494
(803) 435-8765
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2117
SC
152W00000X
Optometrist
4531 T1261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D21171
—
SC
Enumeration date
06/01/2005
Last updated
12/14/2022
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