Organization Active NPI

Dr Larsen Eye Care Inc

  • Optometrist
  • Layton, UT
National Provider Identifier
1215110929
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
375876-9934 Issued in UT
Legal business name
DR LARSEN EYE CARE INC
Practice address
815 W 2000 N
Layton, UT 84041-1632
Phone
(801) 776-4426
Fax
(801) 776-4437
NPI assigned
Dec 17, 2007
Last updated
Dec 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Authorized official

Name
Dr. Michael Craig Larsen, ODNPI 1720152309
Title
Owner
Phone
(801) 776-4426

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 375876-9934 UT Primary

Addresses

Primary practice location

815 W 2000 N
Layton, UT 84041-1632

Mailing address

815 W 2000 N
Layton, UT 84041-1632
Phone (801) 776-4426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050324000510 UT Part B Supplier - Clinic/Group Practice 8224084009 Receives reassigned benefits from 4 practitioners
Practice locations: Hill AFB, UT; Layton, UT
O20090824000067 CA Part B Supplier - Clinic/Group Practice 8224084009 Receives reassigned benefits from 5 practitioners
Practice locations: Travis AFB, CA

National Provider Directory

National Provider Directory

Locations

5800 Westover Ave
Bldg 5800B
Anchorage, AK 99506
Phone (907) 753-7515

7123 N 138th Ave
#1522
Luke AFB, AZ 85307
Phone (623) 536-0332

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1215110929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 W 2000 N",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411632",
            "telephone_number": "801-776-4426",
            "fax_number": "801-776-4437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 W 2000 N",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411632",
            "telephone_number": "801-776-4426",
            "fax_number": "801-776-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR LARSEN EYE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-776-4426",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "375876-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.