Provider Demographics
NPI:1336178185
Name:LOBUE LASER AND EYE CARE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LOBUE LASER AND EYE CARE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LOBUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-696-1135
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-696-1135
Mailing Address - Fax:951-304-9068
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-696-1135
Practice Address - Fax:951-304-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG598470207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27875ZMedicare ID - Type Unspecified