1891753174 NPI number — CARY S LABBE O.D.

Table of content: CARY S LABBE O.D. (NPI 1891753174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891753174 NPI number — CARY S LABBE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABBE
Provider First Name:
CARY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LABBE-STEELE
Provider Other First Name:
CARY
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1891753174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 FLAT ROCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76450-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-452-0855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 SANTA FE DR STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-798-2020
Provider Business Practice Location Address Fax Number:
817-789-6290
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  03260TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1060568-06 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005407412 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00058567 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00E66D . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0339830001 . This is a "PALMETTO GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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