Individual
DR. JASON MARK LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT12133TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1757666
—
AK
01
—
410039591
RAILROAD MEDICARE
CA
05
—
SDO121330
—
CA
01
—
ZZZ13445Z
MEDICARE GROUP NUMBER
CA
Enumeration date
06/06/2006
Last updated
04/13/2026
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