Provider Demographics
NPI:1760543060
Name:SPECTOR, LARRY NEIL (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEIL
Last Name:SPECTOR
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 1:255 FOREST STREET EXT
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2714
Mailing Address - Country:US
Mailing Address - Phone:203-787-7111
Mailing Address - Fax:203-787-3512
Practice Address - Street 1:1044 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2434
Practice Address - Country:US
Practice Address - Phone:203-787-7111
Practice Address - Fax:203-787-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004053054Medicaid