Provider Demographics
NPI:1407806763
Name:ALBERS, MITCHELL H (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:H
Last Name:ALBERS
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 1:1965 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5168
Mailing Address - Country:US
Mailing Address - Phone:651-777-3555
Mailing Address - Fax:651-777-4459
Practice Address - Street 1:1965 11TH AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5167
Practice Address - Country:US
Practice Address - Phone:651-777-3555
Practice Address - Fax:651-777-4459
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410023607OtherRAILROAD MEDICARE
MN410023607OtherRAILROAD MEDICARE