Healthcare Provider Details

I. General information

NPI: 1770104549
Provider Name (Legal Business Name): ERICA JILL BOBB OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 VIRGINIA AVE
COLLINSVILLE VA
24078-1935
US

IV. Provider business mailing address

7665 CEDAR DR # DT
PASADENA MD
21122-1905
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-3766
  • Fax:
Mailing address:
  • Phone: 240-286-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3056
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002993
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3177
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: