Provider Demographics
NPI:1235290594
Name:LARSON, JULIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 FALLS VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1073
Mailing Address - Country:US
Mailing Address - Phone:970-255-1026
Mailing Address - Fax:
Practice Address - Street 1:2545 RIMROCK AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8664
Practice Address - Country:US
Practice Address - Phone:970-263-4525
Practice Address - Fax:970-248-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2269152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management