Provider Demographics
NPI:1407159940
Name:KARL M. LARSEN,O.D., LTD.
Entity Type:Organization
Organization Name:KARL M. LARSEN,O.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:MARTELL
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-790-2400
Mailing Address - Street 1:8660 W CHEYENNE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7455
Mailing Address - Country:US
Mailing Address - Phone:702-790-2400
Mailing Address - Fax:702-790-2441
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:702-790-2400
Practice Address - Fax:702-790-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV25-02549Medicaid
NVV530243702Medicare PIN
NVEC334AMedicare PIN
NV25-02549Medicaid
NV0360230001Medicare NSC