Provider Demographics
NPI:1083363360
Name:TEBON, ERICA (OD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TEBON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9481 E MANSFIELD AVE UNIT 207
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7297
Mailing Address - Country:US
Mailing Address - Phone:563-599-4386
Mailing Address - Fax:
Practice Address - Street 1:3155 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8703
Practice Address - Country:US
Practice Address - Phone:719-653-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002612152W00000X
390200000X
COOPT.0003876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program