Provider Demographics
NPI:1811220601
Name:ANDERSON, ERIN R (OD)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:R
Last Name:ANDERSON
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 1:4706 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2918
Mailing Address - Country:US
Mailing Address - Phone:412-831-7757
Mailing Address - Fax:724-941-6310
Practice Address - Street 1:4706 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2918
Practice Address - Country:US
Practice Address - Phone:412-831-7757
Practice Address - Fax:724-941-6310
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002269152W00000X
MS892-94463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02306OtherMEDICARE GROUP
MS1922067016OtherPICAYUNE EYE CLINIC NPI
MS1811220601OtherNPI
MS335470YYAUMedicare UPIN