Provider Demographics
NPI:1053392522
Name:ALBRECHT, TROY W (OD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:W
Last Name:ALBRECHT
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 1:1415 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3159
Mailing Address - Country:US
Mailing Address - Phone:319-377-5343
Mailing Address - Fax:319-447-6119
Practice Address - Street 1:1415 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3159
Practice Address - Country:US
Practice Address - Phone:319-377-5343
Practice Address - Fax:319-447-6119
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1202762Medicaid
IAI8025Medicare ID - Type UnspecifiedMEDICARE
IAU78421Medicare UPIN