Provider Demographics
NPI:1851488639
Name:ERIKSEN, STEVEN E (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:ERIKSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16528 CLEVELAND ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4460
Mailing Address - Country:US
Mailing Address - Phone:425-885-1974
Mailing Address - Fax:425-882-7818
Practice Address - Street 1:16528 CLEVELAND ST
Practice Address - Street 2:SUITE I
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4460
Practice Address - Country:US
Practice Address - Phone:425-885-1974
Practice Address - Fax:425-882-7818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 0001073152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2258309Medicaid
WAG000101484OtherMEDICARE LEGACY PROVIDER NUMBER
WAT83862Medicare UPIN