Provider Demographics
NPI:1861580169
Name:ANKLIN, ERIC THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:THOMAS
Last Name:ANKLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:904 W CHICAGO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1298
Mailing Address - Country:US
Mailing Address - Phone:517-423-7447
Mailing Address - Fax:517-423-7030
Practice Address - Street 1:904 W CHICAGO BLVD
Practice Address - Street 2:STE A
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1298
Practice Address - Country:US
Practice Address - Phone:517-423-2001
Practice Address - Fax:517-423-7030
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU95375Medicare UPIN