Healthcare Provider Details

I. General information

NPI: 1871476804
Provider Name (Legal Business Name): ERIE FAMILY OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 VILLAGE VISTA DRIVE
ERIE CO
80516-4521
US

IV. Provider business mailing address

4875 WARD ROAD STE 600
WHEAT RIDGE CO
80033-1944
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-9456
  • Fax: 303-467-0145
Mailing address:
  • Phone: 303-463-9990
  • Fax: 303-463-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE BRIDGES
Title or Position: PRACTICE ADMINISTRATOR/CEO
Credential:
Phone: 303-463-5784