Provider Demographics
NPI:1154410918
Name:DEPOE, LAURA C (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:DEPOE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:BLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:550 EAGLES LANDING PARKWAY
Mailing Address - Street 2:STE 208
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-474-1237
Mailing Address - Fax:770-474-5224
Practice Address - Street 1:550 EAGLES LANDING PARKWAY
Practice Address - Street 2:STE 208
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-474-1237
Practice Address - Fax:770-474-5224
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist