Provider Demographics
NPI:1316022262
Name:IGE, ERIC BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRIAN
Last Name:IGE
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 1:17523 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3403
Mailing Address - Country:US
Mailing Address - Phone:310-327-9693
Mailing Address - Fax:310-327-9699
Practice Address - Street 1:17523 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3403
Practice Address - Country:US
Practice Address - Phone:310-327-9693
Practice Address - Fax:310-327-9699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10529T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105290Medicaid
CASD0105290Medicaid
CAWY121Medicare ID - Type Unspecified