Provider Demographics
NPI:1245378801
Name:ALBERT W. HAPPEL, OD, PC
Entity Type:Organization
Organization Name:ALBERT W. HAPPEL, OD, PC
Other - Org Name:ANDERSON VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-642-4769
Mailing Address - Street 1:3330 N STATE ROAD 9
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 N STATE ROAD 9
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1238
Practice Address - Country:US
Practice Address - Phone:765-642-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100058720Medicare PIN