Organization
KATHRYN LARSSON, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN LARSSON OD (OPTOMETRIST/ OWNER)
(209) 526-9883
Entity
Organization
Contact information
Practice address
1150 W ORANGEBURG AVE, MODESTO, CA 95350-4042
(209) 526-9883
(209) 526-8681
Mailing address
1150 W ORANGEBURG AVE, MODESTO, CA 95350-4042
(209) 526-9883
(209) 526-8681
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
9225T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6012490001
—
CA
Enumeration date
06/07/2018
Last updated
06/07/2018
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