Provider Demographics
NPI:1538053277
Name:LARSON, TRAVIS ADAM (OD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:ADAM
Last Name:LARSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHRINER ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-1155
Mailing Address - Country:US
Mailing Address - Phone:605-624-2020
Mailing Address - Fax:
Practice Address - Street 1:11 SHRINER ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1155
Practice Address - Country:US
Practice Address - Phone:605-624-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist