Provider Demographics
NPI:1679232706
Name:LABOY, EVANGELINA (LDO)
Entity Type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:
Last Name:LABOY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2555
Mailing Address - Country:US
Mailing Address - Phone:919-455-6683
Mailing Address - Fax:
Practice Address - Street 1:10 LINCOLN SQ
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1135
Practice Address - Country:US
Practice Address - Phone:508-373-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6309156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty