Healthcare Provider Details

I. General information

NPI: 1114627940
Provider Name (Legal Business Name): ERIN FOLLEN OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 04/19/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62968 O B RILEY RD STE 11
BEND OR
97703-9443
US

IV. Provider business mailing address

62968 O B RILEY RD STE 11
BEND OR
97703-9443
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-2020
  • Fax: 541-382-5004
Mailing address:
  • Phone: 541-382-2020
  • Fax: 541-382-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ERIN FOLLEN
Title or Position: OWNER/DOCTOR
Credential: OD
Phone: 541-382-2020