Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3111 | MN |
NPI | 1003091471 |
---|---|
Provider Name | Dr. Tamra L Larson |
First Address | Edina, MN 55435-5960 |
Second Address | Edina, MN 55435-5960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2008 |
Last Update Date | 04/01/2008 |