Provider Demographics
NPI:1003091471
Name:LARSON, TAMRA L (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:L
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 1:3300 EDINBOROUGH WAY STE 412
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5960
Mailing Address - Country:US
Mailing Address - Phone:952-835-3201
Mailing Address - Fax:
Practice Address - Street 1:3300 EDINBOROUGH WAY STE 412
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5960
Practice Address - Country:US
Practice Address - Phone:952-835-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist