Provider Demographics
NPI:1912034273
Name:BELKA, LAURA (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BELKA
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:PO BOX 117556
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7556
Mailing Address - Country:US
Mailing Address - Phone:888-856-1878
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:10 WILLIAM POPE DR STE 6
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7550
Practice Address - Country:US
Practice Address - Phone:843-842-2020
Practice Address - Fax:843-705-1512
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD14296Medicaid
SCD14296Medicaid
SCAA19816691Medicare PIN
SCAA19815531Medicare PIN