Provider Demographics
NPI:1467298828
Name:SHIN, ERICA EUNSEO (OD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:EUNSEO
Last Name:SHIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5755 GLENRIDGE DR UNIT 162
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5552
Mailing Address - Country:US
Mailing Address - Phone:404-989-5685
Mailing Address - Fax:
Practice Address - Street 1:50 MAIN STREET MARKET PL SE STE 100
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3311
Practice Address - Country:US
Practice Address - Phone:770-382-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003654152W00000X
TX11104T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist