Provider Demographics
NPI:1740333772
Name:COOPER-ERICKSON, BETTY JANE (OD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JANE
Last Name:COOPER-ERICKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1813
Mailing Address - Country:US
Mailing Address - Phone:805-983-2377
Mailing Address - Fax:
Practice Address - Street 1:2001 E VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1813
Practice Address - Country:US
Practice Address - Phone:805-983-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8383T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist