Provider Demographics
NPI:1346220605
Name:EVANS, ALBERT CARLETON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CARLETON
Last Name:EVANS
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:PO BOX 150026
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-0026
Mailing Address - Country:US
Mailing Address - Phone:239-573-8774
Mailing Address - Fax:
Practice Address - Street 1:325 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2244
Practice Address - Country:US
Practice Address - Phone:239-573-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-001738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5360ZOtherPTAN
FLT93883Medicare UPIN
FLU5360ZMedicare PIN