Healthcare Provider Details

I. General information

NPI: 1326459843
Provider Name (Legal Business Name): DR LARSEN EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 A ST MCCHORD MAIN EXCHANGE
FT. LEWIS MCCHORD AFB WA
98438
US

IV. Provider business mailing address

3025 W 75 N
LAYTON UT
84041-5747
US

V. Phone/Fax

Practice location:
  • Phone: 801-513-9951
  • Fax:
Mailing address:
  • Phone: 801-513-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C LARSEN
Title or Position: OWNER
Credential: OD
Phone: 801-513-9951