Provider Demographics
NPI:1982197687
Name:DAGOBERT, ALBERTA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTA
Middle Name:
Last Name:DAGOBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4732
Mailing Address - Country:US
Mailing Address - Phone:305-945-7301
Mailing Address - Fax:
Practice Address - Street 1:8590 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2336
Practice Address - Country:US
Practice Address - Phone:305-223-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003299152W00000X
PAOEG004076152W00000X
FLOPC5535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC5535Medicaid