Provider Demographics
NPI:1437635240
Name:LARSON, JULIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:KATSEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:420 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 2ND ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6514
Practice Address - Country:US
Practice Address - Phone:805-252-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist