Provider Demographics
NPI:1821160201
Name:LARSON, CHRISTY L (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:L
Last Name:LARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8625
Mailing Address - Country:US
Mailing Address - Phone:407-333-3937
Mailing Address - Fax:407-333-4500
Practice Address - Street 1:5680 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8625
Practice Address - Country:US
Practice Address - Phone:407-333-3937
Practice Address - Fax:407-333-4500
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP3069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69098Medicare UPIN