Provider Demographics
NPI:1194760454
Name:ERIKA DUGGAN
Entity type:Organization
Organization Name:ERIKA DUGGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-456-9585
Mailing Address - Street 1:10120 S EASTERN AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3951
Mailing Address - Country:US
Mailing Address - Phone:702-456-9585
Mailing Address - Fax:702-456-0011
Practice Address - Street 1:10120 S EASTERN AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3951
Practice Address - Country:US
Practice Address - Phone:702-456-9585
Practice Address - Fax:702-456-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11552105OtherCAQH
NVFT528AMedicare PIN
11552105OtherCAQH
NVV104550Medicare PIN