Individual
DR. NATHAN MICHAEL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1255 APPLETON RD, MENASHA, WI 54952-1501
(920) 722-6872
Mailing address
1255 APPLETON RD, MENASHA, WI 54952-1501
(920) 722-6872
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3916-35
WI
Other
Enumeration date
06/07/2023
Last updated
06/08/2023
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