Provider Demographics
NPI:1598945859
Name:CS LARSON OD & ASSOCIATES PC
Entity type:Organization
Organization Name:CS LARSON OD & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-774-2040
Mailing Address - Street 1:1390 HIGHWAY F
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-0000
Mailing Address - Country:US
Mailing Address - Phone:573-774-2040
Mailing Address - Fax:573-774-6152
Practice Address - Street 1:1390 HIGHWAY F
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-0000
Practice Address - Country:US
Practice Address - Phone:573-774-2040
Practice Address - Fax:573-774-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598945859OtherTRICARE FOR LIFE
1598945859OtherGOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC
1598945859OtherPHYSICIANS MUTUAL
1598945859OtherCONTINENTAL LIFE INSURANCE COMPANY
1598945859OtherBLUE CROOS BLUE SHIELD OF MINNESOTA
1598945859OtherCARPTENTERS' HEALTH & WELFARE TRUST FUND OF ST. LOUIS
1598945859OtherLA FIREMEN'S RELIEF ASSOC
1598945859OtherLIFE INVESTORS INSURANCE
916309OtherADVANTRA FREEDOM
1598945859OtherUNITED HEATHCARE INSURANCE COMPANY
1598945859OtherBLUE SHIELD OF CALIFORNIA
1598945859OtherMUTUAL OF OMAHA COMPANIES
1598945859OtherCOMBINED INSURANCE COMPANY OF AMERICA
MO1598945859Medicaid
1598945859OtherAMERICAN REPUBLIC INSURANCE COMPANY
1598945859OtherEPOCH
7102000MO65583OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
000000414171OtherANTHEM
1598945859OtherAMERICAN PIONEER
1598945859OtherBANKERS LIFE
1598945859OtherCOALITION OR PUBLIC SAFETY US HEALTH AND LIFE INSURANCE COMPANY
1598945859OtherCOOPERATIVE BENEFIT ADMINISTRATORS, INC
1598945859OtherHUMANA EMPLOYERS HEALTH INSURANCE
1598945859OtherMERITAIN HEALTH
002613709OtherAPWU HEALTH PLAN
1598945859OtherCONSECO INSURANCE COMPANY
650016650016OtherPREMERA
1598945859OtherBLUD CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
1598945859OtherUNITED WORLD LIFE INSURANCE
1598945859OtherCHAMPVA
2381519OtherGROUP HEALTH PLAN
0007812292OtherAETNA
1598945859OtherADMIRAL LIFE INSURANCE COMPANY OF AMERICA
1598945859OtherPHILADELPHIA AMERICAN LIFE
1598945859OtherCHRISTIAN FIDELITY LIFE INSURANCE COMPANY
1598945859OtherDEFINITY HEALTH
1598945859OtherEQUITABLE LIFE & CASUALTY INSURANCE COMPANY
1598945859OtherHARTFORD LIFE INSURANCE COMPANY
1598945859OtherNATIONAL ASSOCIATION OF LETTER CARRIERS HEALTH BENEFIT PLAN
1598945859OtherPALMETTO GBA - RAILROAD MEDICARE
2195676OtherMAIL HANDLERS BENEFIT PLAN
1598945859OtherTRICARE WEST
1598945859OtherAMERICAN FAMILY INSURANCE
1598945859OtherSTANDARD LIFE & ACCIDENT COMPANY
1598945859OtherUNITED AMERICAN INSURANCE COMPANY
1598945859OtherBENICORP INSURANCE COMPANY
1598945859OtherAMERICAN CONTINENTAL INSURANCE COMPANY
1598945859OtherCONSTRUCTION INDUSTRY LABORERS WELFARE FUND
2195676OtherMAIL HANDLERS BENEFIT PLAN