Provider Demographics
NPI:1063401024
Name:BINFORD, LARRY WINN (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WINN
Last Name:BINFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-0789
Mailing Address - Country:US
Mailing Address - Phone:409-925-2506
Mailing Address - Fax:
Practice Address - Street 1:13135 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7681
Practice Address - Country:US
Practice Address - Phone:409-925-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2589TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12211Medicare UPIN
TX00E08CMedicare PIN
TX0221880001Medicare NSC