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General NPI Number Information
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NPI Number | 1326131350
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Entity Type | Organization
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Legal Business Name | LARSEN VISION CLINIC PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1940 E 1ST ST
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City | CASPER
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State | WY
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Zip | 82601-2747
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Country | US
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Telephone | 307-266-9988
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Fax | 307-266-9992
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Provider Business Mailing Address
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Address Line | 2959 PHEASANT DR
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City | CASPER
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State | WY
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Zip | 82604-4306
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Country | US
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Telephone | 307-333-4407
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RYAN PATRICK LARSEN
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Credential | O.D.
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Telephone | 307-266-9988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 309T
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License Number State | WY
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