Provider Demographics
NPI:1598805368
Name:DEFEVER, ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:DEFEVER
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 1:19329 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2833
Mailing Address - Country:US
Mailing Address - Phone:313-881-3249
Mailing Address - Fax:313-881-0124
Practice Address - Street 1:19329 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2833
Practice Address - Country:US
Practice Address - Phone:313-881-3249
Practice Address - Fax:313-881-0124
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU50769Medicare UPIN