Provider Demographics
NPI:1194750265
Name:LLABRES, CARLOS M (OD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:LLABRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:CARLOS
Other - Middle Name:M
Other - Last Name:LLABRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1862 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5960
Practice Address - Country:US
Practice Address - Phone:678-432-1584
Practice Address - Fax:678-432-6258
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001480152W00000X
GA1480T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist