Provider Demographics
NPI:1104853696
Name:LAUBACH, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LAUBACH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 PEARLGRASS CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR
Practice Address - Street 2:STE 110
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2723
Practice Address - Country:US
Practice Address - Phone:925-463-7330
Practice Address - Fax:925-463-7337
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist