Individual
JEFFREY STEPHEN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5100 GAMBLE DR SUITE 100, MAIL STOP 31200A, SAINT LOUIS PARK, MN 55416-1582
(952) 593-8777
(952) 595-6408
Mailing address
8100 34TH AVE S, 21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7961
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1999
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057523200
—
MN
Enumeration date
03/02/2006
Last updated
10/05/2011
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