Individual
JODIE S LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
302 N HARTH AVE, MADISON, SD 57042-2219
(605) 256-6911
(605) 256-9017
Mailing address
PO BOX 388, MADISON, SD 57042-0388
(605) 256-6911
(605) 256-9017
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
619
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
865819600
—
MN
05
—
9203640
—
SD
Enumeration date
09/19/2005
Last updated
10/09/2007
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