Provider Demographics
NPI:1245264191
Name:TARRANT, LARRY D (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:TARRANT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:104 E US HIGHWAY 80
Practice Address - Street 2:SUITE 100
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8615
Practice Address - Country:US
Practice Address - Phone:972-552-2020
Practice Address - Fax:972-552-1701
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5597TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038435603Medicaid
TXU72495Medicare UPIN
TX038435603Medicaid