Provider Demographics
NPI:1760445605
Name:BROWN, ERIKA HOUSTON (OD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:HOUSTON
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:LEIGH
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:5615 S NC 41 HWY
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-6216
Practice Address - Country:US
Practice Address - Phone:910-285-5050
Practice Address - Fax:910-285-2968
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0925JOtherBCBS PROV #
NC410048650OtherRR MEDICARE INDIVIDUAL #
NC890925JMedicaid
NC0925JOtherBCBS PROV #
NC2471707DMedicare PIN
NC2471707CMedicare PIN