Provider Demographics
NPI:1326131350
Name:LARSEN VISION CLINIC PC
Entity Type:Organization
Organization Name:LARSEN VISION CLINIC PC
Other - Org Name:FIRST STREET VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-266-9988
Mailing Address - Street 1:2959 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4306
Mailing Address - Country:US
Mailing Address - Phone:307-333-4407
Mailing Address - Fax:
Practice Address - Street 1:1940 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2747
Practice Address - Country:US
Practice Address - Phone:307-266-9988
Practice Address - Fax:307-266-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY309T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty