Individual
DR. MICHELE M ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1401 33RD ST S, FARGO, ND 58103-3429
(701) 232-5311
(701) 232-5311
Mailing address
1401 33RD ST S, FARGO, ND 58103-3429
(701) 232-5311
(701) 232-5311
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
507
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026124
BLUE SHIELD OF ND
ND
01
—
509601016599
PREFERRED ONE
ND
05
—
60549
—
ND
Enumeration date
03/22/2007
Last updated
07/08/2007
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