Provider Demographics
NPI:1982785663
Name:LABORDE EYE GROUP HOME OF THE MACULA CENTER OF N CAROLINA PLLC
Entity Type:Organization
Organization Name:LABORDE EYE GROUP HOME OF THE MACULA CENTER OF N CAROLINA PLLC
Other - Org Name:LABORDE EYE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-693-0747
Mailing Address - Street 1:630 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4206
Mailing Address - Country:US
Mailing Address - Phone:828-693-0747
Mailing Address - Fax:828-693-0947
Practice Address - Street 1:630 5TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4206
Practice Address - Country:US
Practice Address - Phone:828-693-0747
Practice Address - Fax:828-693-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-34067207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905771Medicaid
NC2335520Medicare PIN