Provider Demographics
NPI:1356337471
Name:ERICHSON, THOMAS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:ERICHSON
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 1:1 BUSHWICK RD STE B
Mailing Address - Street 2:LAGRANGE PROFESSIONAL BUILDING
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3839
Mailing Address - Country:US
Mailing Address - Phone:845-471-1147
Mailing Address - Fax:845-473-1849
Practice Address - Street 1:1 BUSHWICK RD STE B
Practice Address - Street 2:LAGRANGE PROFESSIONAL BUILDING
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3839
Practice Address - Country:US
Practice Address - Phone:845-471-1147
Practice Address - Fax:845-473-1849
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C9390OtherHEALTHNET PROV #
NY141816850OtherPOMCO PROV #
NY2218214OtherAETNA HMO
NYC37061OtherEMPIRE BC/BS PROV #
NYP1954861OtherOXFORD PROV #
NY10034123 GRP6170OtherCDPHP PROV #
NY597024OtherMVP PROV. #
NY2218214OtherAETNA HMO
NY2C9390OtherHEALTHNET PROV #