MEDICARE: LARSON STAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1154735728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARSON STAIR

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD
Second Line	:	STE. 401
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8458
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	978-313-6824

Provider Business Practice Location Address
First Line	:	6702 W COAL MINE AVE
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-4573
Country	:	US
Telephone Number	:	720-283-2082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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