Individual
BRUCE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
126 W FIRST ST, HINSDALE, IL 60521-4013
(630) 325-5200
(630) 325-5569
Mailing address
126 W FIRST ST, HINSDALE, IL 60521-4013
(630) 325-5200
(630) 325-5569
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36066594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L08359
MEDICARE PTAN
IL
Enumeration date
03/01/2006
Last updated
07/12/2010
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