MEDICARE: DR. LARRY J TAYLOR 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	1580	IA

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	01186	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1518968577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY J TAYLOR O.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 696
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-0696
Country	:	US
Telephone Number	:	319-754-5518
Fax Number	:	319-754-9531

Provider Business Practice Location Address
First Line	:	3031 FLINT HILLS DR
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-0696
Country	:	US
Telephone Number	:	319-754-5518
Fax Number	:	319-754-9531

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/17/2014

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