MEDICARE: OCULOPLASTICS OF SOUTHWEST FLORIDA, DEAN W. LARSON, MD PA

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	207W00000X	Ophthalmology Physician		FL
2	367500000X	Certified Registered Nurse Anesthetist		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC9277	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1275527095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCULOPLASTICS OF SOUTHWEST FLORIDA, DEAN W. LARSON, MD PA

Provider Business Mailing Address
First Line	:	15620 NEW HAMPSHIRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4168
Country	:	US
Telephone Number	:	239-481-9995
Fax Number	:	239-481-9745

Provider Business Practice Location Address
First Line	:	15620 NEW HAMPSHIRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4168
Country	:	US
Telephone Number	:	239-481-9995
Fax Number	:	239-481-9745

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEAN WILLIAM LARSON
Credential	:	MD
Telephone Number	:	239-481-9995

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/11/2025

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