Healthcare Provider Details

I. General information

NPI: 1265736706
Provider Name (Legal Business Name): LARRY D. OXENBERG O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 12/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N DUKE ST
LANCASTER PA
17602-4958
US

IV. Provider business mailing address

326 N DUKE ST
LANCASTER PA
17602-4958
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3798
  • Fax: 717-394-4810
Mailing address:
  • Phone: 717-394-3798
  • Fax: 717-394-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001229
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG001229
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOEG001229
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOEG001229
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOEG001229
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOEG001229
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001229
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1234040
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. LARRY DENNIS OXENBERG
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 717-394-3798