# ROBERT A LARSON OD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881883585
- **Authorized official:** DR. ROBERT ARIC LARSON O.D. (OWNER)
- **Authorized official phone:** (815) 436-8955

## Contact information

- **Practice address:** 15420 S RTE 59, PLAINFIELD, IL 60544-1984
- **Practice address phone:** (815) 436-8955
- **Practice address fax:** (815) 496-8745
- **Mailing address:** 15420 S RTE 59, PLAINFIELD, IL 60544-1984
- **Mailing address phone:** (815) 436-8955
- **Mailing address fax:** (815) 496-8745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2007
- **Last updated:** 10/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0142300001 | PTAN | IL |