Provider Demographics
NPI:1407119001
Name:TYDOR, ERIKA (OD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:TYDOR
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 1:18021 15TH AVE NE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155
Mailing Address - Country:US
Mailing Address - Phone:206-367-8883
Mailing Address - Fax:206-913-2915
Practice Address - Street 1:18021 15TH AVE NE SUITE 100
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155
Practice Address - Country:US
Practice Address - Phone:206-367-8883
Practice Address - Fax:206-913-2915
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60293866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist