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General NPI Number Information
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NPI Number | 1629250436
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Entity Type | Organization
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Legal Business Name | DEON RAE ERICKSON OD INC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 3615 W WOOLBRIGHT RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7244
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Country | US
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Telephone | 561-734-1887
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Fax | 561-736-8991
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Provider Business Mailing Address
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Address Line | 3615 W WOOLBRIGHT RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7244
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Country | US
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Telephone | 561-734-1887
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Fax | 561-736-8991
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DEON RAE ERICKSON
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Credential | O D
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Telephone | 561-734-1887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | FL2628
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License Number State | FL
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