Provider Demographics
NPI:1114185089
Name:LARRY TARRANT O.D.
Entity Type:Organization
Organization Name:LARRY TARRANT O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-551-2000
Mailing Address - Street 1:104 W US HIGHWAY 80
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:972-551-2000
Mailing Address - Fax:972-551-2011
Practice Address - Street 1:1900 W MOORE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2346
Practice Address - Country:US
Practice Address - Phone:972-551-2000
Practice Address - Fax:972-551-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163659901Medicaid
00477UMedicare UPIN