Provider Demographics
NPI:1629382189
Name:LARSON, TRESSA (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:TRESSA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1451 CORAL RIDGE AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2803
Mailing Address - Country:US
Mailing Address - Phone:319-354-5185
Mailing Address - Fax:319-625-2095
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF OPHTHALMOLOGY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2916
Practice Address - Fax:319-384-5540
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA072224152W00000X
MDTA2296152W00000X
PAOEG002348152W00000X
VA0618002067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist