Provider Demographics
NPI:1770680399
Name:LABRECQUE, ALLEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:D
Last Name:LABRECQUE
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 1:2438 N 770 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9720
Mailing Address - Country:US
Mailing Address - Phone:801-773-8824
Mailing Address - Fax:
Practice Address - Street 1:1200 S COMMERCE WAY
Practice Address - Street 2:VISION CENTER
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-3117
Practice Address - Country:US
Practice Address - Phone:435-734-9843
Practice Address - Fax:435-734-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113007-9933152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist