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General NPI Number Information
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NPI Number | 1083871974
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Entity Type | Individual
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Provider Name | BRIAN LARSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 477 E BUTTERFIELD RD STE 105
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City | LOMBARD
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State | IL
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Zip | 60148-5622
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Country | US
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Telephone | 773-943-7425
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Fax | 773-896-0303
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Provider Business Mailing Address
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Address Line | 1S376 SUMMIT AVE STE 4C
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3966
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Country | US
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Telephone | 773-943-7425
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Fax | 773-896-0303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036129978
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 54511
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 036129978
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License Number State | IL
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