Provider Demographics
NPI:1730239492
Name:LABAZA, JOHN F (O D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:LABAZA
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 BALDWIN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:897 BALDWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3384
Practice Address - Country:US
Practice Address - Phone:810-667-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP26460001Medicare ID - Type Unspecified
MIT33066Medicare UPIN