Provider Demographics
NPI:1770104549
Name:BOBB, ERICA JILL (OD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JILL
Last Name:BOBB
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 1:2010 BREMO RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:
Practice Address - Street 1:3029 OLIVER STANLEY TRL
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-0286
Practice Address - Country:US
Practice Address - Phone:240-286-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3056152W00000X
VA0618002993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist