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General NPI Number Information
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NPI Number | 1982134045
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Entity Type | Individual
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Provider Name | LARRY EDWARD KOCIAN JR. OD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 3124 E CENTRAL TEXAS EXPY
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City | KILLEEN
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State | TX
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Zip | 76543-7333
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Country | US
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Telephone | 254-690-4733
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Fax | 254-690-6728
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Provider Business Mailing Address
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Address Line | 2504 JACKSON DR
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-2737
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Country | US
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Telephone | 210-781-5883
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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 | 9258TG
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License Number State | TX
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