Individual
MR. LARS JOHN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5301 S SUPERSTITION MOUNTAIN DR, GOLD CANYON, AZ 85218-1919
(480) 474-2020
Mailing address
7314 E ROOSEVELT ST, SCOTTSDALE, AZ 85257-4021
(602) 373-8821
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1429
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0906570
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
11/07/2006
Last updated
07/09/2007
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