Provider Demographics
NPI:1649227810
Name:LASCAIBAR, ALBERT ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ALEXANDER
Last Name:LASCAIBAR
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 1:11523 PALMBRUSH TRL # 124
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2917
Mailing Address - Country:US
Mailing Address - Phone:941-387-6554
Mailing Address - Fax:
Practice Address - Street 1:1141 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2858
Practice Address - Country:US
Practice Address - Phone:941-567-4675
Practice Address - Fax:941-567-4377
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005809800Medicaid
FL20634Medicare UPIN