Provider Demographics
NPI:1508916537
Name:JOHN F. LABAZA O. D., PLLC
Entity Type:Organization
Organization Name:JOHN F. LABAZA O. D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LABAZA
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:810-667-9210
Mailing Address - Street 1:897 BALDWIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3384
Mailing Address - Country:US
Mailing Address - Phone:810-667-9210
Mailing Address - Fax:
Practice Address - Street 1:897 BALDWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3384
Practice Address - Country:US
Practice Address - Phone:810-667-9210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26460Medicare ID - Type Unspecified
MIY48558Medicare UPIN