Provider Demographics
NPI:1164092276
Name:SAUCEDO, ERIKA (OD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:SAUCEDO
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 1:1824 DEFOOR AVE NW APT 3211
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3034
Mailing Address - Country:US
Mailing Address - Phone:678-642-0254
Mailing Address - Fax:
Practice Address - Street 1:650 NORTH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2749
Practice Address - Country:US
Practice Address - Phone:470-837-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist