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General NPI Number Information
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NPI Number | 1629039961
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Entity Type | Organization
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Legal Business Name | LARSON EYE CARE SC
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1442 N 31ST ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3061
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Country | US
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Telephone | 920-452-5400
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Fax | 920-452-1920
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Provider Business Mailing Address
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Address Line | 1442 N 31ST ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3061
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Country | US
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Telephone | 920-452-5400
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Fax | 920-452-1920
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER L LARSON
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Credential | MD
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Telephone | 920-452-5400
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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 |
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