Provider Demographics
NPI:1306884457
Name:ALBERT, TIMOTHY GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:ALBERT
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:CMR 426
Mailing Address - Street 2:BOX 2
Mailing Address - City:APO AE 09613
Mailing Address - State:PISA
Mailing Address - Zip Code:56100
Mailing Address - Country:IT
Mailing Address - Phone:0113905-054-7357
Mailing Address - Fax:
Practice Address - Street 1:CMR 426
Practice Address - Street 2:BOX 2
Practice Address - City:APO AE 09613
Practice Address - State:PISA
Practice Address - Zip Code:56100
Practice Address - Country:IT
Practice Address - Phone:0113905-054-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8184OtherLICENSE