Provider Demographics
NPI:1982134045
Name:KOCIAN, LARRY EDWARD JR (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EDWARD
Last Name:KOCIAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2504 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2737
Mailing Address - Country:US
Mailing Address - Phone:210-781-5883
Mailing Address - Fax:
Practice Address - Street 1:3124 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7333
Practice Address - Country:US
Practice Address - Phone:254-690-4733
Practice Address - Fax:254-690-6728
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9258TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382733901Medicaid