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General NPI Number Information
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NPI Number | 1750487898
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Entity Type | Individual
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Provider Name | LARRY EDWARD OTWELL OD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 72840 CA-111 S SUITE F201
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-848-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 977 BEL AIR DR
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City | PALM SPRINGS
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State | CA
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Zip | 92264-0663
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Country | US
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Telephone | 206-619-1230
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Fax |
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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 | 1735
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License Number State | WA
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