Basic Information
| Provider Information | |||||||||
| NPI: | 1720152309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025W 75 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840415747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015139951 | ||||||||
| FaxNumber: | 8017799942 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 W 2000 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 375876-9934 | UT | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.