Provider Demographics
NPI:1558477893
Name:SAKSA, ERIC (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SAKSA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W 41ST ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3045
Mailing Address - Country:US
Mailing Address - Phone:218-263-8956
Mailing Address - Fax:218-263-8494
Practice Address - Street 1:990 W 41ST ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3045
Practice Address - Country:US
Practice Address - Phone:218-263-8956
Practice Address - Fax:218-263-8494
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT90754Medicare UPIN