Provider Demographics
NPI:1912389354
Name:BARANWAL, ERICA DANIELLE (OD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:DANIELLE
Last Name:BARANWAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:DANIELLE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3651 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4260
Mailing Address - Country:US
Mailing Address - Phone:614-309-7823
Mailing Address - Fax:
Practice Address - Street 1:505 S VIRGIL AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1406
Practice Address - Country:US
Practice Address - Phone:213-384-5222
Practice Address - Fax:213-380-3937
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35790152W00000X
OHOPT 6355390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes152W00000XEye and Vision Services ProvidersOptometrist