MEDICARE: TODD ERICKSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	593	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013071455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD ERICKSON O.D.

Provider Business Mailing Address
First Line	:	340 W CENTER ST
Second Line	:	SUITE B
City	:	KALISPELL
State	:	MT
Zip	:	59901-4032
Country	:	US
Telephone Number	:	406-755-5171
Fax Number	:	406-755-5182

Provider Business Practice Location Address
First Line	:	340 W CENTER ST
Second Line	:	SUITE B
City	:	KALISPELL
State	:	MT
Zip	:	59901-4032
Country	:	US
Telephone Number	:	406-755-5171
Fax Number	:	406-755-5182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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Directions to “ TODD ERICKSON O.D.” Practice Location

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