Provider Demographics
NPI:1750326237
Name:LARGER, KARLA R (OD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:R
Last Name:LARGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1254
Mailing Address - Country:US
Mailing Address - Phone:419-629-3241
Mailing Address - Fax:419-629-3241
Practice Address - Street 1:431 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-1254
Practice Address - Country:US
Practice Address - Phone:419-629-3241
Practice Address - Fax:419-629-3241
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2186414Medicaid
OH2186414Medicaid
OH5871690001Medicare NSC
OHLA0895727Medicare PIN
OHLA0895727Medicare ID - Type Unspecified