Provider Demographics
NPI:1104001965
Name:BRAY ORTEGA, ERIKA (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:BRAY ORTEGA
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 1:2401 E ORANGEBURG AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3396
Mailing Address - Country:US
Mailing Address - Phone:209-525-8436
Mailing Address - Fax:209-525-8438
Practice Address - Street 1:2401 E ORANGEBURG AVE STE 280
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3396
Practice Address - Country:US
Practice Address - Phone:209-525-8436
Practice Address - Fax:209-525-8438
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist