Larsen, David P

Larsen, David P is an individual health care provider with primary practice located at 1330 N Superior Ave , Tomah WI 54660-1130. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Larsen, David P can be contacted via phone (608) 372-4458.

Contact Information

Primary practice address
1330 N Superior Ave Tomah WI 54660-1130
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2311 Wisconsin

Profile Details

NPI number 1417953308
LBN Legal business name Larsen, David P
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2005
Last updated Jan 21st, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417953308 NPPES
Wisconsin MEDICAID 38581400

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