Provider Demographics
NPI:1861539363
Name:ABERNATHY, LARRY D (O D)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 MANSARD ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-5911
Mailing Address - Country:US
Mailing Address - Phone:940-552-7619
Mailing Address - Fax:
Practice Address - Street 1:3474 CATCLAW DR STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8234
Practice Address - Country:US
Practice Address - Phone:325-695-6633
Practice Address - Fax:325-695-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2222T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist