Healthcare Provider Details

I. General information

NPI: 1275527095
Provider Name (Legal Business Name): OCULOPLASTICS OF SOUTHWEST FLORIDA, DEAN W. LARSON, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15620 NEW HAMPSHIRE CT
FORT MYERS FL
33908-4168
US

IV. Provider business mailing address

15620 NEW HAMPSHIRE CT
FORT MYERS FL
33908-4168
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-9995
  • Fax: 239-481-9745
Mailing address:
  • Phone: 239-481-9995
  • Fax: 239-481-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. DEAN WILLIAM LARSON
Title or Position: PRESIDENT
Credential: MD
Phone: 239-481-9995