Provider Demographics
NPI:1710073630
Name:LARSON, BARBARA C (COT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:LARSON
Suffix:
Gender:F
Credentials:COT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 NW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5495
Mailing Address - Country:US
Mailing Address - Phone:352-331-9793
Mailing Address - Fax:
Practice Address - Street 1:6925 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3101
Practice Address - Country:US
Practice Address - Phone:352-331-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic