Provider Demographics
NPI:1962834069
Name:UNDERWOOD, ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:UNDERWOOD
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 1:6400 BROOKTREE CT STE 220
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9271
Mailing Address - Country:US
Mailing Address - Phone:724-935-5761
Mailing Address - Fax:724-935-2245
Practice Address - Street 1:6400 BROOKTREE CT STE 220
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9271
Practice Address - Country:US
Practice Address - Phone:724-935-5761
Practice Address - Fax:724-935-2245
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8293-T152W00000X
PAOEG003640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326076YWZKMedicare PIN