Provider Demographics
NPI:1205825080
Name:SULLIVAN, ERIN CLEARY (OD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:CLEARY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:STE 5006B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-432-5478
Mailing Address - Fax:314-569-0864
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:OPHTHALMOLOGY CONSULTANTS LTD STE 5006B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-432-5478
Practice Address - Fax:314-569-0864
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003015404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO182433OtherBCBS
MO629885OtherHEALTHLINK
MO182433OtherBCBS