Provider Demographics
NPI:1780755033
Name:LARKIN, WILLIAM P (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:LARKIN
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 1:1413 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5725
Mailing Address - Country:US
Mailing Address - Phone:812-372-1919
Mailing Address - Fax:812-375-0863
Practice Address - Street 1:1413 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5725
Practice Address - Country:US
Practice Address - Phone:812-372-1919
Practice Address - Fax:812-375-0863
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002025A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN054540Medicare ID - Type Unspecified
INM400038784Medicare PIN
INT83377Medicare UPIN