Provider Demographics
NPI:1417280769
Name:POOLE, ERICA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:POOLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:905 PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4110
Mailing Address - Country:US
Mailing Address - Phone:904-264-1206
Mailing Address - Fax:904-264-3685
Practice Address - Street 1:905 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4110
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:904-264-3685
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist