ANNGELIQUE JANET BIZZARO (OD) – Optometrist, NPI 1811636228

ANNGELIQUE JANET BIZZARO (OD) is a healthcare provider. based in South jordan, Utah. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. 12872545-9934 (UT). The NPI Number for ANNGELIQUE JANET BIZZARO (OD) is 1811636228

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
ANNGELIQUE JANET BIZZARO (OD)
NPI
1811636228
Phone
(801) 214-0327
Address
11514 S 4000 W STE 103
Enumeration Date
2 June 2022
Last Update Date
2 June 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8013632851
Graduation Year
2022 (4 years ago)
PAC ID
1759762024
Group Practice PAC ID
8820534886
Professional Enrollment ID
I20220718002178
Address ID
UT841021454SA160XX1000301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:4State licenses:1Digital endpointsOther names

312 OPTOMETRY in UT

Provider Addresses for ANNGELIQUE JANET BIZZARO (OD)

  • 11514 S 4000 W STE 103

    SOUTH JORDAN, UT 840096016

    Phone: (801) 214-0327

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 22 Open Payments records for all available years, with a total value of $826.

Total Amount is formed as General ($826) + Research ($0) + Ownership ($0) = $826.

Last reported payment date: 2024-06-27 • Largest payer in this snapshot: Bausch & Lomb Americas Inc. ($412).

Total Amount

$826

General + Research + Ownership

Payments

22

Total payment records

General Amount

$826

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-27

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-07-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220718002178IOptometryUTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84009)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8820534886View full group profile
NameSpecialtyState
O P T O M E T R YUT

Reviews

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Frequently asked questions

What is the 10-digit NPI for ANNGELIQUE JANET BIZZARO (OD)?
ANNGELIQUE JANET BIZZARO (OD) — NPI 1811636228 — is the standard way to identify this listing.
Can I rely on ANNGELIQUE JANET BIZZARO (OD) being an active provider?
As of the registry snapshot, ANNGELIQUE JANET BIZZARO (OD) is marked active.
What is ANNGELIQUE JANET BIZZARO (OD)'s specialty?
The listing groups ANNGELIQUE JANET BIZZARO (OD) with Optometrist. Clinical services aligned with this taxonomy classification.
Where should I expect ANNGELIQUE JANET BIZZARO (OD) on a map?
Expect South Jordan, Utah as a primary anchor for ANNGELIQUE JANET BIZZARO (OD) unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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