Provider Demographics
NPI:1245211093
Name:LAIBL, EDWARD V (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:V
Last Name:LAIBL
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 1:2194 HIGHWAY A1A
Mailing Address - Street 2:SUITE 109
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4930
Mailing Address - Country:US
Mailing Address - Phone:321-777-1670
Mailing Address - Fax:321-773-0187
Practice Address - Street 1:2194 HIGHWAY A1A
Practice Address - Street 2:SUITE 109
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4930
Practice Address - Country:US
Practice Address - Phone:321-777-1670
Practice Address - Fax:321-773-0187
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15251OtherBCBS
FLT85153Medicare UPIN
FL15251OtherBCBS
FL19251Medicare ID - Type Unspecified
FL19251Medicare PIN