Healthcare Provider Details

I. General information

NPI: 1891893442
Provider Name (Legal Business Name): TERESA ANN ERICKSON WILLS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA A ERICKSON OD

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MERIDIAN E STE 18
MILTON WA
98354-7003
US

IV. Provider business mailing address

900 MERIDIAN E STE 18
MILTON WA
98354-7003
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-5252
  • Fax: 253-927-4270
Mailing address:
  • Phone: 253-927-5252
  • Fax: 253-927-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: