Provider Demographics
NPI:1902986433
Name:OSTENSO, ERIK A (O D)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:A
Last Name:OSTENSO
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MINER AVE W
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1721
Mailing Address - Country:US
Mailing Address - Phone:715-532-3006
Mailing Address - Fax:715-532-9656
Practice Address - Street 1:119 MINER AVE W
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1721
Practice Address - Country:US
Practice Address - Phone:715-532-3006
Practice Address - Fax:715-532-9656
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38582600Medicaid
WI000087759Medicare ID - Type UnspecifiedMEDICARE
WIU20487Medicare UPIN
WV410049002Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI38582600Medicaid
WI0293450001Medicare NSC