Basic Information
| Provider Information | |||||||||
| NPI: | 1720061021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OXENBERG | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 GOOD DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176034359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173972020 | ||||||||
| FaxNumber: | 7173990220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OEG001229 | PA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | OEG001229 | PA | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WX0102X | OEG001229 | PA | N | Eye and Vision Services Providers | Optometrist | Occupational Vision | 152W00000X | OEG001229 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.