Provider Demographics
NPI:1124197868
Name:LAUB, DENNIS R (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:LAUB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:R
Other - Last Name:LAUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:107 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43469-1333
Mailing Address - Country:US
Mailing Address - Phone:419-849-3811
Mailing Address - Fax:419-849-3374
Practice Address - Street 1:107 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469-1333
Practice Address - Country:US
Practice Address - Phone:419-849-3811
Practice Address - Fax:419-849-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3075T937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303399Medicaid
OH0450101Medicare ID - Type UnspecifiedGENOFF
OH0450102Medicare ID - Type UnspecifiedOAKOFF
OH0450103Medicare ID - Type UnspecifiedWOODOFF
OH0377420001Medicare NSC
OH0303399Medicaid
OH0374420002Medicare NSC