Provider Demographics
NPI:1588628630
Name:SHERBURNE, ALBERT L (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:SHERBURNE
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 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-863-8833
Mailing Address - Fax:781-652-8762
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:SUITE 11
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-863-8833
Practice Address - Fax:781-652-8762
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT59266Medicare UPIN
MA178958Medicare ID - Type Unspecified