Provider Demographics
NPI:1265655443
Name:CARBONE, LAURA MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:CARBONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:FRISBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1851 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5911
Mailing Address - Country:US
Mailing Address - Phone:312-307-7452
Mailing Address - Fax:928-774-3878
Practice Address - Street 1:1851 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5911
Practice Address - Country:US
Practice Address - Phone:312-307-7452
Practice Address - Fax:928-774-3878
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009777152W00000X
AZ2041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist