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General NPI Number Information
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NPI Number | 1568799062
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Entity Type | Organization
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Legal Business Name | MICHAEL ERICKSON, O.D.
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 4957 LAKEMONT BLVD SE SUITE C-5
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City | BELLEVUE
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State | WA
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Zip | 98006-7801
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Country | US
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Telephone | 425-746-0908
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Fax | 815-346-3499
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Provider Business Mailing Address
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Address Line | 4957 LAKEMONT BLVD SE SUITE C-5
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City | BELLEVUE
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State | WA
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Zip | 98006-7801
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Country | US
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Telephone | 425-746-0908
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Fax | 815-346-3499
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. MICHAEL DENNIS ERICKSON
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Credential | O.D.
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Telephone | 425-746-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OD00003260
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License Number State | WA
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