# LARRY E BLACKMON

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

## Provider details

- **NPI number:** 1902944341
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 693-077T | LA | Yes |

## Other

- **Enumeration date:** 02/01/2007
- **Last updated:** 02/05/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0617300002 | PALMETTO | LA |
| 05 | — | 1097721 | — | LA |
| 01 | — | 2353B | BLUE CROSS OF LA | LA |
| 01 | — | 2864 | DAVIS VISION | LA |
| 01 | — | LA0693 | EYEMED | LA |