Individual
BRANDON BRUCE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
13195 WEAVER LAKE RD, MAPLE GROVE, MN 55369
(763) 420-5112
(763) 420-6957
Mailing address
13195 WEAVER LAKE RD, MAPLE GROVE, MN 55369
(763) 420-5112
(763) 420-6957
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3284
MN
Other
Enumeration date
06/28/2012
Last updated
06/28/2012
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