MEDICARE: DR. ERICA MADDEN 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	S-C13-TA-827	AL

General Provider Information

NPI Number	:	1346477106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA MADDEN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207243
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7243
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	2550 EASTERN BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1500
Country	:	US
Telephone Number	:	334-274-2020
Fax Number	:	334-396-9924

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

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	10/21/2021

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