Healthcare Provider Details

I. General information

NPI: 1972595767
Provider Name (Legal Business Name): LEANN J LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 BOYSON RD STE 200
HIAWATHA IA
52233-2214
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-8032
  • Fax: 319-362-6098
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-752-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33166
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: