Provider Demographics
NPI:1679808752
Name:BARRETT, ERIN L (OD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:BARRETT
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3265 45TH ST S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7930
Practice Address - Country:US
Practice Address - Phone:701-212-1553
Practice Address - Fax:701-540-0125
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3307152W00000X
WI3275-35152W00000X
ND750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist