Provider Demographics
NPI:1417144718
Name:JOHNSON CARDER, ERICA D (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:JOHNSON CARDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:DAWN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1902
Mailing Address - Country:US
Mailing Address - Phone:734-665-5306
Mailing Address - Fax:734-665-5522
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1902
Practice Address - Country:US
Practice Address - Phone:734-665-5306
Practice Address - Fax:734-665-5522
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13410TPA152W00000X
MI4901004753152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy