Provider Demographics
NPI:1326459843
Name:DR LARSEN EYE CARE INC
Entity Type:Organization
Organization Name:DR LARSEN EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-513-9951
Mailing Address - Street 1:3025 W 75 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5747
Mailing Address - Country:US
Mailing Address - Phone:801-513-9951
Mailing Address - Fax:
Practice Address - Street 1:504 A ST MCCHORD MAIN EXCHANGE
Practice Address - Street 2:
Practice Address - City:FT. LEWIS MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438
Practice Address - Country:US
Practice Address - Phone:801-513-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty