Provider Demographics
NPI:1508029216
Name:OTOO, ERICA (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:OTOO
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 1:832 COURLANDT AVENUE
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:212-222-6100
Mailing Address - Fax:212-222-6606
Practice Address - Street 1:167 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1320
Practice Address - Country:US
Practice Address - Phone:212-222-6100
Practice Address - Fax:212-222-6606
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0072671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist