Provider Demographics
NPI:1366672354
Name:LABOMBARDA, MARIA A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:LABOMBARDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARK PL
Mailing Address - Street 2:SAM'S CLUB OPTICAL
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3653
Mailing Address - Country:US
Mailing Address - Phone:201-974-0871
Mailing Address - Fax:
Practice Address - Street 1:300 PARK PL
Practice Address - Street 2:SAM'S CLUB OPTICAL
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3653
Practice Address - Country:US
Practice Address - Phone:201-974-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA06620300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist