Provider Demographics
NPI:1881626000
Name:DALTON, ERIN ANDERSON (OD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANDERSON
Last Name:DALTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JANE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:22400 SALAMO RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8269
Mailing Address - Country:US
Mailing Address - Phone:503-722-7737
Mailing Address - Fax:503-722-4152
Practice Address - Street 1:22400 SALAMO RD
Practice Address - Street 2:STE. 100
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8269
Practice Address - Country:US
Practice Address - Phone:503-722-7737
Practice Address - Fax:503-722-4152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3380AT152W00000X
CT002680152W00000X
OR3380-ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500635089Medicaid
CT004264256Medicaid
ORR159461Medicare PIN
ORR159828Medicare PIN