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General NPI Number Information
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NPI Number | 1104853696
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Entity Type | Individual
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Provider Name | EDWARD LAUBACH O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 5980 STONERIDGE DR STE 110
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City | PLEASANTON
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State | CA
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Zip | 94588-2723
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Country | US
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Telephone | 925-463-7330
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Fax | 925-463-7337
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Provider Business Mailing Address
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Address Line | 118 PEARLGRASS CT
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City | SAN RAMON
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State | CA
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Zip | 94582-5534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9720
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License Number State | CA
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