Provider Demographics
NPI:1366484628
Name:CASE, ERIN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:CASE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:CASE
Other - Last Name:BROOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3615 WOOLBRIGHT RD.
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436
Mailing Address - Country:US
Mailing Address - Phone:561-734-1887
Mailing Address - Fax:386-253-1193
Practice Address - Street 1:3615 WOOLBRIGHT RD.
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436
Practice Address - Country:US
Practice Address - Phone:561-734-1887
Practice Address - Fax:386-253-1193
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2982152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620842800Medicaid
FL620842800Medicaid
FLU69447Medicare UPIN