Healthcare Provider Details

I. General information

NPI: 1124027073
Provider Name (Legal Business Name): ROBERT L ALBERTSON JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOWLER AVE
BERWICK PA
18603-3326
US

IV. Provider business mailing address

500 FOWLER AVE
BERWICK PA
18603-3326
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-0365
  • Fax: 570-759-0385
Mailing address:
  • Phone: 570-759-0365
  • Fax: 570-759-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000465
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: