Basic Information
| Provider Information | |||||||||
| NPI: | 1215110929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR LARSEN EYE CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 W 2000 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
| FaxNumber: | 8017764437 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 W 2000 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
| FaxNumber: | 8017764437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2007 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | LARSEN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8017764426 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 375876-9934 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.