Provider Demographics
NPI:1962845032
Name:DAVID R. ALBRECHT O.D. P.C.
Entity Type:Organization
Organization Name:DAVID R. ALBRECHT O.D. P.C.
Other - Org Name:EYETOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-438-2020
Mailing Address - Street 1:15 SOUTH 100 EAST
Mailing Address - Street 2:PO BOX 111
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-0111
Mailing Address - Country:US
Mailing Address - Phone:435-438-2020
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH 100 EAST
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347546-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529536175003Medicaid
UTU68380Medicare UPIN
UT529536175003Medicaid