MEDICARE: DR. EDWARD V LAIBL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC827	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15251	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1245211093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD V LAIBL OD

Provider Business Mailing Address
First Line	:	2194 HIGHWAY A1A
Second Line	:	SUITE 109
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-1670
Fax Number	:	321-773-0187

Provider Business Practice Location Address
First Line	:	2194 HIGHWAY A1A
Second Line	:	SUITE 109
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-1670
Fax Number	:	321-773-0187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/20/2008

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Directions to “ DR. EDWARD V LAIBL OD” Practice Location

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