Provider Demographics
NPI:1821144379
Name:FRANK LARUSSA OPTOMETRY LLC
Entity Type:Organization
Organization Name:FRANK LARUSSA OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LARUSSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:205-945-9728
Mailing Address - Street 1:210 MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-290-9403
Mailing Address - Fax:
Practice Address - Street 1:210 MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5121
Practice Address - Country:US
Practice Address - Phone:205-290-9403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS666 TA-112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty