Larson, Matthew

Larson, Matthew is an individual health care provider with primary practice located at 3450 Lacey Rd , Downers Grove IL 60515-5430. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Larson, Matthew can be contacted via phone (630) 743-4807.

Contact Information

Primary practice address
3450 Lacey Rd Downers Grove IL 60515-5430
Phone: (630) 743-4807
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046010940 Illinois
Eye and Vision Services Providers / Optometrist 152W00000X 18003852A Indiana

Profile Details

NPI number 1316352834
LBN Legal business name Larson, Matthew
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2014
Last updated Nov 17th, 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 1316352834 NPPES
Illinois MEDICAID 046010940

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