Healthcare Provider Details

I. General information

NPI: 1861507238
Provider Name (Legal Business Name): LAURA PRISBE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 EAST BEACH STREET
WATSONVILLE CA
95076-2869
US

IV. Provider business mailing address

195 AVIATION WAY SUITE 200
WATSONVILLE CA
95076-2059
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax: 831-707-2777
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: