Provider Demographics
NPI:1902815111
Name:BLAIR, LARRY L (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
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Mailing Address - Street 1:201 E BOLING HWY
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3238
Mailing Address - Country:US
Mailing Address - Phone:979-532-4500
Mailing Address - Fax:979-532-4500
Practice Address - Street 1:201 E BOLING HWY
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3238
Practice Address - Country:US
Practice Address - Phone:979-532-4500
Practice Address - Fax:979-532-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician