1265629729 NPI number — LARRY L WASHBURN O.D.

Table of content: LARRY L WASHBURN O.D. (NPI 1265629729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265629729 NPI number — LARRY L WASHBURN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHBURN
Provider First Name:
LARRY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265629729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 747
Provider Second Line Business Mailing Address:
505 N FRANKLIN AVE
Provider Business Mailing Address City Name:
COLBY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67701-0747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-462-3348
Provider Business Mailing Address Fax Number:
785-462-3599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N FRANKLIN AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
COLBY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67701-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-462-3348
Provider Business Practice Location Address Fax Number:
785-462-3599
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1111-3 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100090170A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com