Individual
DR. ANGELA M LAVENDER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1669 OWEN DR, FAYETTEVILLE, NC 28304-3425
(910) 323-3698
(910) 323-3491
Mailing address
1669 OWEN DR, FAYETTEVILLE, NC 28304-3425
(910) 323-3698
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
NC1765
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0923M
BLUE CROSS BLUE SHIELD
NC
05
—
890923M
—
NC
Enumeration date
05/16/2006
Last updated
07/08/2007
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