Provider Demographics
NPI:1790396471
Name:BAILEY, ERICA LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LOUISE
Last Name:BAILEY
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LOUISE
Other - Last Name:KETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5611
Mailing Address - Country:US
Mailing Address - Phone:423-238-3290
Mailing Address - Fax:
Practice Address - Street 1:6117 OOLTEWAH GEORGETOWN RD STE 109
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5611
Practice Address - Country:US
Practice Address - Phone:423-238-3290
Practice Address - Fax:423-238-3439
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003389152W00000X
ORATI4538152W00000X
TN3723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist