Individual
DANIEL LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 541-3937
(406) 541-1810
Mailing address
PO BOX 4907, 700 WEST KENT, MISSOULA, MT 59806-4907
(406) 541-3937
(406) 541-1810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
581
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0480964
—
MT
05
—
807213000
—
ID
Enumeration date
09/13/2005
Last updated
04/14/2010
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