Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2002 | IA |
NPI | 1013036425 |
---|---|
Provider Name | George R Alberhasky |
First Address | Iowa City, IA 52246 |
Second Address | Iowa City, IA 52246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 27/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40708 | PTAN (01) | |
V45252 | (02) | IA |