Provider Demographics
NPI:1013036425
Name:ALBERHASKY, GEORGE R (OD, PC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:ALBERHASKY
Suffix:
Gender:M
Credentials:OD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 MORMON TREK BLVD, SUITE 1400
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246
Mailing Address - Country:US
Mailing Address - Phone:319-338-2020
Mailing Address - Fax:319-341-7884
Practice Address - Street 1:2346 MORMON TREK BLVD, SUITE 1400
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246
Practice Address - Country:US
Practice Address - Phone:319-338-2020
Practice Address - Fax:319-341-7884
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
40708OtherPTAN
40708OtherPTAN