Provider Demographics
NPI:1831503028
Name:EBBING, ERIK D (OD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:D
Last Name:EBBING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HOOSICK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2450
Mailing Address - Country:US
Mailing Address - Phone:518-271-0701
Mailing Address - Fax:518-274-2077
Practice Address - Street 1:258 HOOSICK ST STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2450
Practice Address - Country:US
Practice Address - Phone:518-271-0701
Practice Address - Fax:518-274-2077
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008132-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03883956Medicaid
NY03883956Medicaid