Individual
DR. JASON MARK LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
508 UPLAND ST, KENAI, AK 99611-8026
(907) 335-7500
Mailing address
PO BOX 84101, SEATTLE, WA 98124-5401
(907) 335-7500
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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