Provider Demographics
NPI:1417063066
Name:O'BRIEN, ERIN COLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:COLEEN
Last Name:O'BRIEN
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 1:7361 W LAKE MEAD BLVD
Mailing Address - Street 2:104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1040
Mailing Address - Country:US
Mailing Address - Phone:702-341-7254
Mailing Address - Fax:702-255-5795
Practice Address - Street 1:7361 W LAKE MEAD BLVD
Practice Address - Street 2:104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1040
Practice Address - Country:US
Practice Address - Phone:702-341-7254
Practice Address - Fax:702-255-5795
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5598152W00000X
IL046.010196152W00000X
NVNV 752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4242821OtherMEDICARE PTAN
OH4242821OtherMEDICARE PTAN