Healthcare Provider Details

I. General information

NPI: 1487024568
Provider Name (Legal Business Name): L.C. ERBE O.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 SW GATLIN BLVD
PORT SAINT LUCIE FL
34953-2757
US

IV. Provider business mailing address

474 SW HOMELAND RD
PORT SAINT LUCIE FL
34953-6278
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-0037
  • Fax:
Mailing address:
  • Phone: 772-873-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3336
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC 3336
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOPC 3336
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPC 3336
License Number StateFL

VIII. Authorized Official

Name: DR. LYNNE C ERBE
Title or Position: OWNER
Credential: OD
Phone: 772-873-0037