Provider Demographics
NPI:1003014556
Name:LARSON, BRIANA MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MICHELLE
Last Name:LARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 PECAN PARK BOULEVARD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1206
Mailing Address - Country:US
Mailing Address - Phone:512-401-0400
Mailing Address - Fax:512-401-0403
Practice Address - Street 1:10601 PECAN PARK BOULEVARD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1206
Practice Address - Country:US
Practice Address - Phone:512-401-0400
Practice Address - Fax:512-401-0403
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007195152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy