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General NPI Number Information
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NPI Number | 1649227810
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Entity Type | Individual
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Provider Name | ALBERT ALEXANDER LASCAIBAR O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1141 53RD AVE W
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City | BRADENTON
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State | FL
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Zip | 34207-2858
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Country | US
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Telephone | 941-567-4675
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Fax | 941-567-4377
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Provider Business Mailing Address
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Address Line | 11523 PALMBRUSH TRL # 124
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2917
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Country | US
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Telephone | 941-387-6554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2433
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License Number State | FL
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