Provider Demographics
NPI:1851716161
Name:ERIC T. ANKLIN, OD, PC
Entity Type:Organization
Organization Name:ERIC T. ANKLIN, OD, PC
Other - Org Name:ANKLIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-423-7447
Mailing Address - Street 1:904 W CHICAGO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1298
Mailing Address - Country:US
Mailing Address - Phone:517-423-7447
Mailing Address - Fax:517-423-7030
Practice Address - Street 1:904 W CHICAGO BLVD STE A
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1298
Practice Address - Country:US
Practice Address - Phone:517-423-7447
Practice Address - Fax:517-423-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-23
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95375Medicare UPIN