Provider Demographics
NPI:1255445623
Name:AUYOUNG, ERICK H (OD)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:H
Last Name:AUYOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:608 39TH AVE SW APT D305
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5908
Mailing Address - Country:US
Mailing Address - Phone:253-445-7963
Mailing Address - Fax:
Practice Address - Street 1:504 BARNES BLVD
Practice Address - Street 2:
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438-1304
Practice Address - Country:US
Practice Address - Phone:253-588-1731
Practice Address - Fax:253-588-1741
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07677Medicare UPIN