Albert Fonticoba, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000907 Issued in PA

Practice address

330 W Oregon Ave
Philadelphia, PA 19148-4723

Phone

(215) 463-5889

Fax

(215) 755-6959

NPI assigned

Jun 14, 2005

Reactivated

Mar 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1093710402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W OREGON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191484723",
            "telephone_number": "215-463-5889",
            "fax_number": "215-755-6959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W OREGON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191484723",
            "telephone_number": "215-463-5889",
            "fax_number": "215-755-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTICOBA",
        "first_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2026-07-13",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306195",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John R Fontanilla, M.D.
• Sarah Rose Fonte, LCSW
• Ateh Fonteh, MD
• Anna Budd Fontenot, CRNP
• Cameron James Fontenot, MD
• Jovani Fontil, M.A.
• Russell Foo, M.D.
• Food Is Good
• William Fredrick Foos Jr., MD
• Foot and Ankle Center of Philadelphia

• Optometrist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.