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General NPI Number Information
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NPI Number | 1780163691
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Entity Type | Individual
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Provider Name | ALAYNA LARSEN OD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 12/12/2021
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Provider Practice Location Address
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Address Line | 11735 POINTE PL
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City | ROSWELL
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State | GA
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Zip | 30076-4636
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Country | US
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Telephone | 954-262-4235
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Fax | 954-262-3904
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Provider Business Mailing Address
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Address Line | 155 HOPEWELL GROVE DR
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City | MILTON
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State | GA
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Zip | 30004-6989
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Country | US
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Telephone | 561-356-5619
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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 | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPT003208
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License Number State | GA
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