Jeffrey Stephen Larson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1999 Issued in MN

Practice address

5100 Gamble Dr Suite 100
Mail Stop 31200a
Saint Louis Park, MN 55416-1582

Phone

(952) 593-8777

Fax

(952) 595-6408

NPI assigned

Mar 2, 2006

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 1

Other names 1

• Jeff Larson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1497722904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 34TH AVE S",
            "address_2": "21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251672",
            "telephone_number": "952-883-7961",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 GAMBLE DR SUITE 100",
            "address_2": "MAIL STOP 31200A",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161582",
            "telephone_number": "952-593-8777",
            "fax_number": "952-595-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JEFFREY",
        "middle_name": "STEPHEN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057523200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFF",
            "last_name": "LARSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Austin Larsen
• Lauren Larsen, CRNA
• Brenda R Larson, MD
• Janet L Larson, M.D.
• Jeffrey Arthur Larson, PHARMD
• Katlin Louise Larson
• Leslie Anne Larson, RN
• Lois M Larson, PT
• Nicole M Larson, G.N.P.
• Shey J Larson, C.N.P.

• Optometrist in Saint Louis Park, MN
• Providers in Saint Louis Park, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; 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.