Active NPI
Larry K Siders, O.D.
- Optometrist
- Mount Vernon, OH
National Provider Identifier
1609231141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3373 T970
- Practice address
- 110 Coshocton Ave
Mount Vernon, OH 43050-2628 - Phone
- (740) 392-4000
- NPI assigned
- Dec 29, 2015
- 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 | 3373 T970 | OH | Primary |
Addresses
Primary practice location
110 Coshocton Ave
Mount Vernon, OH 43050-2628
Mailing address
1141 N Reedsburg Rd
Wooster, OH 44691-9331
Phone (330) 749-0415
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3373 T970 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451347200000",
"number": "1609231141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1141 N REEDSBURG RD",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446919331",
"telephone_number": "330-749-0415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 COSHOCTON AVE",
"city": "MOUNT VERNON",
"state": "OH",
"postal_code": "430502628",
"telephone_number": "740-392-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDERS",
"first_name": "LARRY",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-29",
"last_updated": "2015-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3373 T970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.