Provider Demographics
NPI:1659785301
Name:IGNE, ERIN LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LOUISE
Last Name:IGNE
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 1:501 N CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2744
Mailing Address - Country:US
Mailing Address - Phone:657-217-0670
Mailing Address - Fax:
Practice Address - Street 1:501 N CORNELL AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2744
Practice Address - Country:US
Practice Address - Phone:714-525-3350
Practice Address - Fax:714-525-1310
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14967 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659785301OtherNPI
CACB252710Medicare UPIN