Provider Demographics
NPI:1992467534
Name:ALBERTY, GIANCARLO RICCARDO (OD)
Entity Type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:RICCARDO
Last Name:ALBERTY
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 1:1313 E BURNSIDE ST APT 516
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1251
Mailing Address - Country:US
Mailing Address - Phone:954-993-8375
Mailing Address - Fax:
Practice Address - Street 1:10970 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5368
Practice Address - Country:US
Practice Address - Phone:503-214-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5971152W00000X
ORAT4585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist