Provider Demographics
NPI:1669691689
Name:TODA, LARRY M (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:TODA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1605 S WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2132
Mailing Address - Country:US
Mailing Address - Phone:206-322-2345
Mailing Address - Fax:206-322-2347
Practice Address - Street 1:1605 S WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2132
Practice Address - Country:US
Practice Address - Phone:206-322-2345
Practice Address - Fax:206-322-2347
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1402TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2070902Medicaid
TO1868Medicare UPIN