# LARSON EYE CENTER LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bruce C Larson MD & Assoc Ltd
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083643902
- **Authorized official:** DR. BRUCE C LARSON MD (PRESIDENT)
- **Authorized official phone:** (630) 325-5200

## Contact information

- **Practice address:** 126 W FIRST ST, HINSDALE, IL 60521
- **Practice address phone:** (630) 325-5200
- **Practice address fax:** (630) 325-5569
- **Mailing address:** 126 W FIRST ST, HINSDALE, IL 60521
- **Mailing address phone:** (630) 325-5200
- **Mailing address fax:** (630) 325-5569

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 08/25/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0346350001 | NCS | IL |
| 01 | — | 1083643902 | BCBS | IL |
| 01 | — | 2201499 | BCBS | — |
| 01 | — | 759791 | MEDCIARE PTAN | IL |