Active NPI
Dylen Adair Larsen, ABOC
- Optician
- Belvidere, IL
National Provider Identifier
1023379773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Practice address
- 521 South Street
Suite 1
Belvidere, IL 61008 - Phone
- (815) 520-1303
- Fax
- (815) 975-9327
- NPI assigned
- May 30, 2012
- Last updated
- May 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | IL | Primary |
Addresses
Primary practice location
521 South Street
Suite 1
Belvidere, IL 61008
Mailing address
521 South Street
Suite 1
Belvidere, IL 61008
Phone (815) 520-1303
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338336000000",
"number": "1023379773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "521 SOUTH STREET",
"address_2": "SUITE 1",
"city": "BELVIDERE",
"state": "IL",
"postal_code": "61008",
"telephone_number": "815-520-1303",
"fax_number": "815-975-9327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "521 SOUTH STREET",
"address_2": "SUITE 1",
"city": "BELVIDERE",
"state": "IL",
"postal_code": "61008",
"telephone_number": "815-520-1303",
"fax_number": "815-975-9327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "DYLEN",
"middle_name": "ADAIR",
"name_prefix": "Mr.",
"credential": "ABOC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-30",
"last_updated": "2012-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belvidere, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.