Provider Demographics
NPI:1497886279
Name:POLUKOSHKO, ERIN (OD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:POLUKOSHKO
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:PO BOX 18822
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0018
Mailing Address - Country:US
Mailing Address - Phone:775-828-2300
Mailing Address - Fax:
Practice Address - Street 1:5595 S VIRGINIA ST STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6077
Practice Address - Country:US
Practice Address - Phone:775-828-2300
Practice Address - Fax:775-829-9391
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist