Provider Demographics
NPI:1700818473
Name:LONDON, LARRY N (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:N
Last Name:LONDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 FAIRFAX DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1703
Mailing Address - Country:US
Mailing Address - Phone:703-522-3454
Mailing Address - Fax:703-522-9636
Practice Address - Street 1:3800 FAIRFAX DR STE 1
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1703
Practice Address - Country:US
Practice Address - Phone:703-522-3454
Practice Address - Fax:703-522-9636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410042860OtherRAILROAD MEDICARE
VA0861510001Medicare NSC
VAT30996Medicare UPIN
VA176966L49Medicare PIN