Provider Demographics
NPI:1902081037
Name:PAUL K ALBERT OD
Entity Type:Organization
Organization Name:PAUL K ALBERT OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:207-667-4237
Mailing Address - Street 1:125 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605
Mailing Address - Country:US
Mailing Address - Phone:207-667-4237
Mailing Address - Fax:207-667-0390
Practice Address - Street 1:125 OAK STREET
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:207-667-4237
Practice Address - Fax:207-667-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0688250001Medicare NSC