Fonticoba, Albert

Fonticoba, Albert is an individual health care provider with primary practice located at 330 W Oregon Ave , Philadelphia PA 19148-4723. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Fonticoba, Albert can be contacted via phone (215) 463-5889.

Contact Information

Primary practice address
330 W Oregon Ave Philadelphia PA 19148-4723
Phone: (215) 463-5889
Fax: (215) 755-6959
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OEG000907 Pennsylvania

Profile Details

NPI number 1093710402
LBN Legal business name Fonticoba, Albert
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093710402 NPPES
Pennsylvania MEDICAID 1306195

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