William David Larson, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD10715 Issued in OR

Practice address

19250 SW 65TH Ave
Ste 215
Tualatin, OR 97062-7452

Phone

(503) 692-3630

Fax

(503) 692-3420

NPI assigned

Nov 28, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• W David Larson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oregon Eye Specialists PC

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1770752321
  NPD (past)
• Oregon Eye Specialists, PC

  • Eyewear Supplier
  • Tualatin, OR
  • NPI 1548379506
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1083697635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 SW MACADAM AVE",
            "address_2": "SUITE 216",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393507",
            "telephone_number": "503-244-8601",
            "fax_number": "503-244-3013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE",
            "address_2": "STE 215",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627452",
            "telephone_number": "503-692-3630",
            "fax_number": "503-692-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "WILLIAM",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD10715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060087",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180002095",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "W",
            "last_name": "LARSON",
            "middle_name": "DAVID",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lakeside Family & Cosmetic Dentistry, LLC
• Norzom Lala
• Jourden David Lamar
• Maeran Landers, M.D.
• Alexandra Lapp
• Kathleen Marie Laughlin, M.D
• Laura Nepveu, M.D., P.C.
• Lauren Lavery, OTR
• Heather Lawrence, M.A., BCBA
• Tracy Lynn Lawson-Allen, CPM, LDM

• Ophthalmology Physician in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Ophthalmology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.