Healthcare Provider Details

I. General information

NPI: 1396796710
Provider Name (Legal Business Name): JULI A LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HINESBURG RD SUITE 201
SOUTH BURLINGTON VT
05403-7613
US

IV. Provider business mailing address

1100 HINESBURG RD SUITE 201
SOUTH BURLINGTON VT
05403-7613
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-1808
  • Fax:
Mailing address:
  • Phone: 802-862-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number255565-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25565-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0420008600
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: