Provider Demographics
NPI:1144232323
Name:ALBRECHT, KENT S (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:S
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 DIAGONAL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2878
Mailing Address - Country:US
Mailing Address - Phone:435-673-3201
Mailing Address - Fax:435-673-3552
Practice Address - Street 1:10 DIAGONAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2878
Practice Address - Country:US
Practice Address - Phone:435-673-3201
Practice Address - Fax:435-673-3552
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91112294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78127Medicare UPIN
UT90493Medicare ID - Type Unspecified