Provider Demographics
NPI:1083643902
Name:LARSON EYE CENTER LTD
Entity Type:Organization
Organization Name:LARSON EYE CENTER LTD
Other - Org Name:BRUCE C LARSON MD & ASSOC LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-325-5200
Mailing Address - Street 1:126 W FIRST ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-325-5200
Mailing Address - Fax:630-325-5569
Practice Address - Street 1:126 W FIRST ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-325-5200
Practice Address - Fax:630-325-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1083643902OtherBCBS
2201499OtherBCBS
IL759791OtherMEDCIARE PTAN
IL0346350001OtherNCS
IL0346350001Medicare NSC
IL1083643902OtherBCBS
IL759791OtherMEDCIARE PTAN