Provider Demographics
NPI:1831285626
Name:ALBRECHT, DAVID RICHARD (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:ALBRECHT
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:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-0111
Mailing Address - Country:US
Mailing Address - Phone:435-438-2233
Mailing Address - Fax:
Practice Address - Street 1:15 S. 100 E.
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-0111
Practice Address - Country:US
Practice Address - Phone:435-438-2020
Practice Address - Fax:435-438-3121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347546-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU68380Medicare UPIN
UT000090596Medicare ID - Type Unspecified