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General NPI Number Information
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NPI Number | 1639223969
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Entity Type | Individual
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Provider Name | AARON ROY LARSEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 4802 S PADRE ISLAND DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4202
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Country | US
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Telephone | 361-693-5859
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Fax | 361-288-7132
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Provider Business Mailing Address
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Address Line | 4802 S PADRE ISLAND DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4202
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Country | US
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Telephone | 361-693-5859
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Fax | 361-288-7132
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6508TG
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License Number State | TX
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