Provider Demographics
NPI:1780163691
Name:LARSEN, ALAYNA (OD)
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOPEWELL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6989
Mailing Address - Country:US
Mailing Address - Phone:561-356-5619
Mailing Address - Fax:
Practice Address - Street 1:11735 POINTE PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:954-262-4235
Practice Address - Fax:954-262-3904
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003208152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty