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General NPI Number Information
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NPI Number | 1275527095
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Entity Type | Organization
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Legal Business Name | OCULOPLASTICS OF SOUTHWEST FLORIDA, DEAN W. LARSON, MD PA
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 15620 NEW HAMPSHIRE CT
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City | FORT MYERS
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State | FL
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Zip | 33908-4168
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Country | US
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Telephone | 239-481-9995
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Fax | 239-481-9745
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Provider Business Mailing Address
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Address Line | 15620 NEW HAMPSHIRE CT
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City | FORT MYERS
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State | FL
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Zip | 33908-4168
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Country | US
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Telephone | 239-481-9995
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Fax | 239-481-9745
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEAN WILLIAM LARSON
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Credential | MD
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Telephone | 239-481-9995
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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 |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | FL
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