Provider Demographics
NPI:1518096395
Name:VELASCO, ALBERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:VELASCO
Suffix:JR
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 1:4830 LONGWATER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4216
Mailing Address - Country:US
Mailing Address - Phone:813-818-9488
Mailing Address - Fax:
Practice Address - Street 1:7902 CITRUS PARK TOWN CENTER MALL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3179
Practice Address - Country:US
Practice Address - Phone:813-926-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19037Medicare ID - Type Unspecified
FLT84025Medicare UPIN