Provider Demographics
NPI:1932120409
Name:ERICKSON, RICHARD C (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:ERICKSON
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 1:479 OLD UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-3029
Mailing Address - Country:US
Mailing Address - Phone:978-537-3900
Mailing Address - Fax:978-537-6030
Practice Address - Street 1:479 OLD UNION TPKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-3029
Practice Address - Country:US
Practice Address - Phone:978-537-3900
Practice Address - Fax:978-537-6030
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0350982Medicaid
ME433258Medicare PIN
MA0350982Medicaid