Provider Demographics
NPI:1114191012
Name:LATOUR, LARRY J (OD PA)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:LATOUR
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15551 NW US HIGHWAY 441 UNIT 110
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-9330
Mailing Address - Country:US
Mailing Address - Phone:386-462-7772
Mailing Address - Fax:386-462-1122
Practice Address - Street 1:15551 NW US HIGHWAY 441 UNIT 110
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-9330
Practice Address - Country:US
Practice Address - Phone:386-462-7772
Practice Address - Fax:386-462-1122
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84253Medicare UPIN