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General NPI Number Information
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NPI Number | 1619184850
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Entity Type | Organization
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Legal Business Name | LABAZA EYECARE, P.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1638 STONY CREEK DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1783
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Country | US
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Telephone | 810-523-4552
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 STONY CREEK DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1783
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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 | PRESIDENT
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Name | DR. JOHN LABAZA
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Credential |
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Telephone | 810-523-4552
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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 | 4901002702
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License Number State | MI
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