Individual
DR. LAURIE JEAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2440 W MASON ST, GREEN BAY, WI 54303-4711
(920) 405-9165
(920) 405-9296
Mailing address
3963 PRESQUE ISLE CT, GREEN BAY, WI 54301-1086
(920) 265-4122
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2929-035
WI
Other
Enumeration date
07/21/2006
Last updated
07/09/2007
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