MEDICARE: LARRY J TAYLOR PC

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	1580	IA

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
2	10279	OTHER	IA	BCBS

General Provider Information

NPI Number	:	1699725275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY J TAYLOR PC

Provider Business Mailing Address
First Line	:	3031 FLINT HILLS DR
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 FLINT HILLS DR
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1754
Country	:	US
Telephone Number	:	319-754-5518
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LARRY J. TAYLOR
Credential	:	O.D.
Telephone Number	:	319-754-5518

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/27/2014

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