Provider Demographics
NPI:1851434153
Name:ERICKSEN, CARLA JANE (OD)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JANE
Last Name:ERICKSEN
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 1:5550 S 59TH ST STE 25
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2398
Mailing Address - Country:US
Mailing Address - Phone:402-261-8699
Mailing Address - Fax:
Practice Address - Street 1:5550 S 59TH ST STE 25
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2398
Practice Address - Country:US
Practice Address - Phone:402-261-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1226152W00000X, 152W00000X
OH5858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
252859OtherMIDLANDS CHOICE
34245OtherBC BS OF NEBRASKA
252859OtherMIDLANDS CHOICE
34245OtherBC BS OF NEBRASKA