Provider Demographics
NPI:1285634626
Name:ALBURN, ROGER W (OD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:ALBURN
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 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BUILDING B SUITE 200
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-696-1230
Mailing Address - Fax:610-918-0803
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BUILDING B SUITE 200
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-1230
Practice Address - Fax:610-918-0803
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001761662Medicaid
PA0017616620002Medicaid
U60664Medicare UPIN
PA848738H65Medicare ID - Type Unspecified
PA848738H6SMedicare PIN