Provider Demographics
NPI:1720061021
Name:OXENBERG, LARRY DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DENNIS
Last Name:OXENBERG
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 1:1950 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 1:180 GOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4359
Practice Address - Country:US
Practice Address - Phone:717-397-2020
Practice Address - Fax:717-399-0220
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001229152WC0802X, 152WP0200X, 152WX0102X, 152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0530400001Medicare NSC
PAOX578427Medicare ID - Type Unspecified
PAU01470Medicare UPIN