Healthcare Provider Details

I. General information

NPI: 1538423652
Provider Name (Legal Business Name): ERIK WILLIAM ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 06/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E FONTANERO ST #201
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

1420 LITTLE RAVEN ST UNIT A
DENVER CO
80202-6207
US

V. Phone/Fax

Practice location:
  • Phone: 719-579-2020
  • Fax: 719-632-6088
Mailing address:
  • Phone: 224-267-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0056857
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: