Active NPI
Douglas Floyd Larsen, O.D.
- Optometrist
- Temecula, CA
National Provider Identifier
1124183686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8403T
- Practice address
- 41238 Margarita Rd
Suite 105
Temecula, CA 92591-5552 - Phone
- (951) 699-1111
- Fax
- (951) 699-0101
- NPI assigned
- Dec 26, 2006
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8403T | CA | Primary |
Addresses
Primary practice location
41238 Margarita Rd
Suite 105
Temecula, CA 92591-5552
Mailing address
41238 Margarita Rd
Suite 105
Temecula, CA 92591-5552
Phone (951) 699-1111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8403T | Other | CA | STATE LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8403T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Komm Medical Eye & Vision Group, LTD. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Bethesda, MD
- NPI 1164582441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362528000000",
"number": "1124183686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41238 MARGARITA RD",
"address_2": "SUITE 105",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925915552",
"telephone_number": "951-699-1111",
"fax_number": "951-699-0101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41238 MARGARITA RD",
"address_2": "SUITE 105",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925915552",
"telephone_number": "951-699-1111",
"fax_number": "951-699-0101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "DOUGLAS",
"middle_name": "FLOYD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2013-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "8403T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "8403T",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Temecula, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.