Provider Demographics
NPI:1598078123
Name:LATTER, ERIN TATUM (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:TATUM
Last Name:LATTER
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 860666
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66286-0666
Mailing Address - Country:US
Mailing Address - Phone:913-787-0196
Mailing Address - Fax:913-273-1044
Practice Address - Street 1:15700 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9321
Practice Address - Country:US
Practice Address - Phone:913-787-0196
Practice Address - Fax:913-273-1044
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1872152W00000X
MDTA2220152W00000X
MO2010032151152W00000X
FLOPC 4543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist