Individual
ALAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
733 MARQUETTE AVE, SUITE 219, MINNEAPOLIS, MN 55402-2309
(612) 332-6656
(612) 904-2438
Mailing address
PO BOX 848448, DALLAS, TX 75284-8448
(210) 340-3531
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1901
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
468723000
—
MN
Enumeration date
12/20/2006
Last updated
04/03/2014
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