Provider Demographics
NPI:1851623482
Name:COTTEN, LARRY CLAY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:CLAY
Last Name:COTTEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 LAKE WORTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE WORTH
Mailing Address - State:TEXAS
Mailing Address - Zip Code:76135
Mailing Address - Country:UM
Mailing Address - Phone:817-626-9533
Mailing Address - Fax:
Practice Address - Street 1:6306 LAKE WORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3608
Practice Address - Country:US
Practice Address - Phone:817-626-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX090096156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician