Provider Demographics
NPI:1033151394
Name:DUCHARME, ALBERT RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RICHARD
Last Name:DUCHARME
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SHELFER ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3929
Mailing Address - Country:US
Mailing Address - Phone:352-728-1700
Mailing Address - Fax:352-728-0057
Practice Address - Street 1:1320 SHELFER ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3929
Practice Address - Country:US
Practice Address - Phone:352-728-1700
Practice Address - Fax:352-728-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84052Medicare UPIN
FL19234Medicare ID - Type Unspecified