# LARRY TATE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1336559186
- **Gender:** Man
- **Credential:** LDO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | 0567 | KY | Yes |

## Other

- **Enumeration date:** 05/02/2014
- **Last updated:** 05/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 52905676 | — | KY |