Provider Demographics
NPI:1841460888
Name:ODLING, ERIC ROY (LP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ROY
Last Name:ODLING
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-0021
Mailing Address - Country:US
Mailing Address - Phone:254-883-2003
Mailing Address - Fax:254-883-2427
Practice Address - Street 1:1204 WALKER ROAD
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-0021
Practice Address - Country:US
Practice Address - Phone:254-883-2003
Practice Address - Fax:254-883-2427
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101273OtherLC#
TX6182230001Medicare NSC