Provider Demographics
NPI:1558508952
Name:DR. PHILIP LARRABEE AND ASSOCIATES OPTOMETRISTS, LLC
Entity Type:Organization
Organization Name:DR. PHILIP LARRABEE AND ASSOCIATES OPTOMETRISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRABEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-880-3320
Mailing Address - Street 1:4617 LEONARD PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-359-1035
Mailing Address - Fax:804-359-1035
Practice Address - Street 1:12200 CHATTANOOGA PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4865
Practice Address - Country:US
Practice Address - Phone:804-744-7327
Practice Address - Fax:804-744-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000324152W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty