Healthcare Provider Details

I. General information

NPI: 1093773798
Provider Name (Legal Business Name): LARRY KEBO, OD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JENSEN AVE
SANGER CA
93657-2413
US

IV. Provider business mailing address

1400 JENSEN AVE
SANGER CA
93657-2413
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-4515
  • Fax: 559-875-9155
Mailing address:
  • Phone: 559-875-4515
  • Fax: 559-875-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY KEBO
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 559-875-4515