Provider Demographics
NPI:1336234582
Name:EHRLICH, EDWARD A (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:EHRLICH
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 1:13 PLAID PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3621
Mailing Address - Country:US
Mailing Address - Phone:518-383-1495
Mailing Address - Fax:
Practice Address - Street 1:10 GLENRIDGE RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12302-4524
Practice Address - Country:US
Practice Address - Phone:518-881-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948114Medicaid
T26665Medicare UPIN
39025BMedicare ID - Type UnspecifiedSEARS