Provider Demographics
NPI:1861559924
Name:ALBERTIN, JOANN CARR (OD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:CARR
Last Name:ALBERTIN
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 1:3 BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4201
Mailing Address - Country:US
Mailing Address - Phone:978-263-6904
Mailing Address - Fax:
Practice Address - Street 1:1734 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-6325
Practice Address - Country:US
Practice Address - Phone:978-957-3200
Practice Address - Fax:978-957-4200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAL W17447Medicare ID - Type Unspecified
U91823Medicare UPIN