Provider Demographics
NPI:1124027073
Name:ALBERTSON, ROBERT L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:ALBERTSON
Suffix:JR
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 1:500 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3326
Mailing Address - Country:US
Mailing Address - Phone:570-759-0365
Mailing Address - Fax:570-759-0385
Practice Address - Street 1:500 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3326
Practice Address - Country:US
Practice Address - Phone:570-759-0365
Practice Address - Fax:570-759-0385
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30257Medicare UPIN
413289Medicare ID - Type Unspecified