Provider Demographics
NPI:1215120191
Name:SABINE OPTICAL LABORATORIES INC
Entity type:Organization
Organization Name:SABINE OPTICAL LABORATORIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CARNAGGIO
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:225-924-5460
Mailing Address - Street 1:7515 FLORIDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-924-5460
Mailing Address - Fax:225-924-0988
Practice Address - Street 1:7515 FLORIDA AVENUE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-924-5460
Practice Address - Fax:225-924-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131-131T152W00000X
LA1405-545T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139475Medicaid
LA2120425Medicaid
LA1215120191OtherGROUP NPI
LA1306803713OtherGROUP MEMBER NPI
LA2120425Medicaid
LA5DQ08Medicare PIN