Provider Demographics
NPI:1790396471
Name:BAILEY, ERICA LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LOUISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LOUISE
Other - Last Name:KETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-0317
Mailing Address - Country:US
Mailing Address - Phone:541-519-0256
Mailing Address - Fax:
Practice Address - Street 1:519 W NORTH ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1044
Practice Address - Country:US
Practice Address - Phone:541-426-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist