Provider Demographics
NPI:1588699656
Name:LARSON, CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7202 N MILLBROOK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3341
Mailing Address - Country:US
Mailing Address - Phone:559-439-4151
Mailing Address - Fax:559-439-3762
Practice Address - Street 1:7202 N MILLBROOK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3341
Practice Address - Country:US
Practice Address - Phone:559-439-4151
Practice Address - Fax:559-439-3762
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83358207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G833581Medicaid
CAG23828Medicare UPIN
CA00G833581Medicaid