Provider Demographics
NPI:1558415745
Name:LARSEN, MICHAEL PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:LARSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 CALVINS LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2213
Mailing Address - Country:US
Mailing Address - Phone:978-563-1600
Mailing Address - Fax:603-954-8386
Practice Address - Street 1:59 AUBURN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2428
Practice Address - Country:US
Practice Address - Phone:508-832-8820
Practice Address - Fax:508-721-5145
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW201695OtherCIGNA
MA2202752OtherUNITED HEALTHCARE
MA0334880Medicaid
MA152161OtherHARVARD PILGRIM
MAW16214OtherBLUE CROSS SHIELD
MA0027653OtherNEIGHBORHOOD HEALTH
MA5393688OtherAETNA
MA973954OtherNETWORK HEALTH
MAW17044Medicare PIN
MA152161OtherHARVARD PILGRIM