Healthcare Provider Details

I. General information

NPI: 1962335463
Provider Name (Legal Business Name): ERICA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 IL ROUTE 26 S
FREEPORT IL
61032-9370
US

IV. Provider business mailing address

PO BOX 36
FREEPORT IL
61032-0036
US

V. Phone/Fax

Practice location:
  • Phone: 815-266-2036
  • Fax:
Mailing address:
  • Phone: 720-793-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number269206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: