Individual
DR. ALBERT FONTICOBA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
330 W OREGON AVE, PHILADELPHIA, PA 19148-4723
(215) 463-5889
(215) 755-6959
Mailing address
330 W OREGON AVE, PHILADELPHIA, PA 19148-4723
(215) 463-5889
(215) 755-6959
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000907
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306195
—
PA
Enumeration date
06/14/2005
Last updated
07/08/2007
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