Provider Demographics
NPI:1841447901
Name:UDELL, ERICA LEE (OD)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LEE
Last Name:UDELL
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LEE
Other - Last Name:ROGOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:125 CLAIREMONT AVE STE 485
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2558
Mailing Address - Country:US
Mailing Address - Phone:404-968-9471
Mailing Address - Fax:
Practice Address - Street 1:125 CLAIREMONT AVE STE 485
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2558
Practice Address - Country:US
Practice Address - Phone:404-968-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007266152W00000X
GAOPT002564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist