Provider Demographics
NPI:1568075679
Name:ERDER-MIKEL, ANNALISA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNALISA
Middle Name:
Last Name:ERDER-MIKEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANNALISA
Other - Middle Name:
Other - Last Name:ERDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:18423 FM 1488 RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8512
Mailing Address - Country:US
Mailing Address - Phone:346-386-0100
Mailing Address - Fax:346-386-0109
Practice Address - Street 1:18423 FM 1488 RD STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8512
Practice Address - Country:US
Practice Address - Phone:346-386-0100
Practice Address - Fax:346-386-0109
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist