Provider Demographics
NPI:1962402131
Name:DENSMORE, ERIKA P (OD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:P
Last Name:DENSMORE
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 1:4413 82ND ST
Mailing Address - Street 2:#110
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3384
Mailing Address - Country:US
Mailing Address - Phone:806-798-7030
Mailing Address - Fax:806-798-2611
Practice Address - Street 1:4413 82ND ST
Practice Address - Street 2:#110
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3384
Practice Address - Country:US
Practice Address - Phone:806-798-7030
Practice Address - Fax:806-798-2611
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5389T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019232001Medicaid
TX019232001Medicaid
TX00E15ZMedicare ID - Type UnspecifiedMEDICARE