Provider Demographics
NPI:1861507238
Name:PRISBE, LAURA (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PRISBE
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 1:195 AVIATION WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2059
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:204 EAST BEACH STREET
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2869
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11803152W00000X
OR2812T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist