Individual
DR. BRADLY KENDALL LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8889 JEWELLA AVE STE C, SHREVEPORT, LA 71118-2138
(318) 686-5227
(381) 686-5283
Mailing address
8889 JEWELLA AVE STE C, SHREVEPORT, LA 71118-2138
(318) 686-5227
(381) 686-5283
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1775-709T
LA
Other
Enumeration date
08/01/2014
Last updated
08/01/2014
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