Healthcare Provider Details

I. General information

NPI: 1528136041
Provider Name (Legal Business Name): ERIN LEE MEWES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 TOWN CTR E SPC G-73
SANTA MARIA CA
93454-5159
US

IV. Provider business mailing address

1981 11TH ST
LOS OSOS CA
93402-2736
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6118
  • Fax:
Mailing address:
  • Phone: 805-458-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15405TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: