| Robert A Larson Od Pc | |
|
15420 S Rte 59 Plainfield IL 60544-1984 | |
| (815) 436-8955 | |
| (815) 496-8745 |
| Full Name | Robert A Larson Od Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15420 S Rte 59, Plainfield, Illinois |
| Authorized Official Name and Position | Robert Aric Larson (OWNER) |
| Authorized Official Contact | 8154368955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert A Larson Od Pc 15420 S Rte 59 Plainfield IL 60544-1984 Ph: (815) 436-8955 | Robert A Larson Od Pc 15420 S Rte 59 Plainfield IL 60544-1984 Ph: (815) 436-8955 |
| NPI Number | 1881883585 |
|---|---|
| Provider Enumeration Date | 10/18/2007 |
| Last Update Date | 10/17/2008 |
| Medicare PECOS PAC ID | 0749350395 |
|---|---|
| Medicare Enrollment ID | O20080609000347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881883585 | NPI | - | NPPES |
| 0142300001 | Other | IL | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Robert Aric Larson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568443091 PECOS PAC ID: 0042213365 Enrollment ID: I20060807000059 |
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