Provider Demographics
NPI:1083793004
Name:LARSEN, ERIC NOEL (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NOEL
Last Name:LARSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7427
Mailing Address - Country:US
Mailing Address - Phone:702-259-3937
Mailing Address - Fax:702-645-6402
Practice Address - Street 1:7324 W CHEYENNE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7427
Practice Address - Country:US
Practice Address - Phone:702-259-3937
Practice Address - Fax:702-645-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV880426207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2502015Medicaid
NV5840350OtherAETNA
NVNV0223OtherNV LICENSE
NV05101OtherMES
NV5840350OtherAETNA
NVNV0223OtherNV LICENSE