Provider Demographics
NPI:1912105255
Name:MISH, ERIKA (OD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:MISH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3134
Mailing Address - Country:US
Mailing Address - Phone:920-921-8290
Mailing Address - Fax:920-921-7112
Practice Address - Street 1:1155 W WINNECONNE AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3693
Practice Address - Country:US
Practice Address - Phone:920-722-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist