Provider Demographics
NPI:1730169996
Name:GIAMPICCOLO, LAURA ELIZABETH (O D)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
Last Name:GIAMPICCOLO
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27001 MOULTON PKWY
Mailing Address - Street 2:SUITE A100
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3600
Mailing Address - Country:US
Mailing Address - Phone:949-362-6552
Mailing Address - Fax:949-362-6566
Practice Address - Street 1:27001 MOULTON PKWY
Practice Address - Street 2:SUITE A100
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3600
Practice Address - Country:US
Practice Address - Phone:949-362-6552
Practice Address - Fax:949-362-6566
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6926T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP6926BMedicare ID - Type Unspecified
CAU80631Medicare UPIN