1710948872 NPI number — DR. ARTHUR W ERICKSON O.D.

Table of content: DR. ARTHUR W ERICKSON O.D. (NPI 1710948872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710948872 NPI number — DR. ARTHUR W ERICKSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON
Provider First Name:
ARTHUR
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710948872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 20TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58703-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-852-3762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 S BROADWAY STE C
Provider Second Line Business Practice Location Address:
STERLING OPTICAL
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-7332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-852-5200
Provider Business Practice Location Address Fax Number:
701-837-0475
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  603 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60562 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168333 . This is a "EYEMED" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 352016 . This is a "NVA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 410049049 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 731645038 . This is a "TRICARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 892756 . This is a "ND VSI" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 22017 . This is a "BCBS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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