Provider Demographics
NPI:1235226523
Name:LARSEN, KARL MARTELL (OD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:MARTELL
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 1:8660 W CHEYENNE AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7455
Mailing Address - Country:US
Mailing Address - Phone:702-259-3937
Mailing Address - Fax:702-645-6402
Practice Address - Street 1:8660 W CHEYENNE AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7455
Practice Address - Country:US
Practice Address - Phone:702-259-3937
Practice Address - Fax:702-645-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV25-02549Medicaid
NV25-02549Medicaid
EC315ZMedicare PIN
NV0360230001Medicare NSC