MEDICARE: DR. LARRY N. LONDON 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	0618000084	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410042860	OTHER	VA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1700818473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY N. LONDON O.D.

Provider Business Mailing Address
First Line	:	3800 FAIRFAX DR STE 1
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1703
Country	:	US
Telephone Number	:	703-522-3454
Fax Number	:	703-522-9636

Provider Business Practice Location Address
First Line	:	3800 FAIRFAX DR STE 1
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1703
Country	:	US
Telephone Number	:	703-522-3454
Fax Number	:	703-522-9636

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/18/2014

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