Provider Demographics
NPI:1083801690
Name:RAYMOND L. ALBERTS, M.D., P.C.
Entity Type:Organization
Organization Name:RAYMOND L. ALBERTS, M.D., P.C.
Other - Org Name:FREEPORT EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-232-1105
Mailing Address - Street 1:1110 S PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4659
Mailing Address - Country:US
Mailing Address - Phone:815-232-1105
Mailing Address - Fax:815-232-3117
Practice Address - Street 1:1110 S PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4659
Practice Address - Country:US
Practice Address - Phone:815-232-1105
Practice Address - Fax:815-232-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184682635OtherNPI
IL1437134509OtherNPI
IL1285635722OtherNPI
IL1184682635OtherNPI
IL1437134509OtherNPI
ILU67136Medicare UPIN
IL305970Medicare PIN
IL1285635722OtherNPI
ILD33977Medicare UPIN