MEDICARE: ERIC NOEL LARSEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	880426207	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5840350	OTHER	NV	AETNA
3	NV0223	OTHER	NV	NV LICENSE
4	05101	OTHER	NV	MES

General Provider Information

NPI Number	:	1083793004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC NOEL LARSEN O.D.

Provider Business Mailing Address
First Line	:	7324 W CHEYENNE AVE
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7427
Country	:	US
Telephone Number	:	702-259-3937
Fax Number	:	702-645-6402

Provider Business Practice Location Address
First Line	:	7324 W CHEYENNE AVE
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7427
Country	:	US
Telephone Number	:	702-259-3937
Fax Number	:	702-645-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/23/2008

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Directions to “ ERIC NOEL LARSEN O.D.” Practice Location

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