Provider Demographics
NPI:1174580641
Name:LAUBACH, STEVEN CRAIG (OD,)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CRAIG
Last Name:LAUBACH
Suffix:
Gender:M
Credentials:OD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 HEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-8951
Mailing Address - Country:US
Mailing Address - Phone:850-656-3937
Mailing Address - Fax:
Practice Address - Street 1:547 N MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-0619
Practice Address - Country:US
Practice Address - Phone:850-224-1184
Practice Address - Fax:850-224-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U27517Medicare UPIN
U27517Medicare UPIN