MEDICARE: DR. LARRY M. MAGNUSON OD

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	152W00000X	Optometrist	877	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417066622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY M. MAGNUSON OD

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-0309
Country	:	US
Telephone Number	:	402-375-5160
Fax Number	:	402-375-3302

Provider Business Practice Location Address
First Line	:	215 W 2ND ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1842
Country	:	US
Telephone Number	:	402-375-5160
Fax Number	:	402-375-3302

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/13/2012

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