Provider Demographics
NPI:1801817820
Name:TALLENT, LARRY A (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:TALLENT
Suffix:
Gender:M
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:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1226
Mailing Address - Country:US
Mailing Address - Phone:864-224-6375
Mailing Address - Fax:864-716-7738
Practice Address - Street 1:1655 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2062
Practice Address - Country:US
Practice Address - Phone:864-224-6375
Practice Address - Fax:864-716-7738
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05279Medicaid
SCD05279Medicaid