Provider Demographics
NPI:1275612293
Name:DUKES, ERIC NEILSEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NEILSEN
Last Name:DUKES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1407
Mailing Address - Country:US
Mailing Address - Phone:541-552-0677
Mailing Address - Fax:541-552-0679
Practice Address - Street 1:2325 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1407
Practice Address - Country:US
Practice Address - Phone:541-552-0677
Practice Address - Fax:541-552-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2413ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150874OtherOMAP
ORU46492Medicare UPIN
OR0000PHDBKMedicare ID - Type Unspecified