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General NPI Number Information
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NPI Number | 1275513467
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Entity Type | Individual
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Provider Name | ERIC M LARSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1885 WEST POINTE DR
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City | OSHKOSH
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State | WI
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Zip | 54902-4174
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Country | US
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Telephone | 920-232-6550
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Fax | 920-232-6552
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Provider Business Mailing Address
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Address Line | PO BOX 2723
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City | OSHKOSH
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State | WI
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Zip | 54903-2723
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Country | US
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Telephone | 920-232-6550
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Fax | 920-232-6552
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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 | 45716
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License Number State | WI
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