Provider Demographics
NPI:1255440467
Name:ALBERT, PAUL K (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:ALBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:278 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3259
Mailing Address - Country:US
Mailing Address - Phone:207-667-0757
Mailing Address - Fax:
Practice Address - Street 1:125 OAK ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1650
Practice Address - Country:US
Practice Address - Phone:207-667-4237
Practice Address - Fax:207-667-0390
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0688250001Medicare NSC
MET79472Medicare UPIN