Provider Demographics
NPI:1639233745
Name:ERMIS, KEVIN LOUIS
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LOUIS
Last Name:ERMIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:L
Other - Last Name:ERMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4850
Mailing Address - Country:US
Mailing Address - Phone:830-278-8470
Mailing Address - Fax:
Practice Address - Street 1:2112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4850
Practice Address - Country:US
Practice Address - Phone:830-278-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3937TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U13988Medicare UPIN
TX00E67SMedicare ID - Type Unspecified