Provider Demographics
NPI:1164454872
Name:FARMER, ERICA J (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:J
Last Name:FARMER
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:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-262-2020
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:20 13TH ST W
Practice Address - Street 2:BOX 1231
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5215
Practice Address - Country:US
Practice Address - Phone:406-262-2020
Practice Address - Fax:406-262-1655
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU83871Medicare UPIN