MEDICARE: GEORGE R ALBERHASKY O.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2002	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40708	OTHER		PTAN

General Provider Information

NPI Number	:	1013036425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE R ALBERHASKY O.D., P.C.

Provider Business Mailing Address
First Line	:	2346 MORMON TREK BLVD, SUITE 1400
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246
Country	:	US
Telephone Number	:	319-338-2020
Fax Number	:	319-341-7884

Provider Business Practice Location Address
First Line	:	2346 MORMON TREK BLVD, SUITE 1400
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246
Country	:	US
Telephone Number	:	319-338-2020
Fax Number	:	319-341-7884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	02/27/2013

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