Individual
JONATHAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1605 1ST ST S, WILLMAR, MN 56201-4234
(320) 235-9060
(320) 235-9062
Mailing address
11103 WEST AVE, SAN ANTONIO, TX 78213-1370
(210) 524-6663
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2140
MN
Other
Enumeration date
12/20/2006
Last updated
07/09/2007
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