Healthcare Provider Details

I. General information

NPI: 1801817820
Provider Name (Legal Business Name): LARRY A TALLENT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E GREENVILLE ST
ANDERSON SC
29621-2062
US

IV. Provider business mailing address

PO BOX 1226
ANDERSON SC
29622-1226
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-6375
  • Fax: 864-716-7738
Mailing address:
  • Phone: 864-224-6375
  • Fax: 864-716-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number527
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: