Devaughn Erickson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1618 Issued in MN

Practice address

306 Main Ave N
Roseau, MN 56751-1820

Phone

(218) 463-2020

Fax

(218) 463-2055

NPI assigned

Feb 16, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Warroad, MN
  • NPI 1861562340
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821132754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 MAIN AVE N",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511820",
            "telephone_number": "218-463-2020",
            "fax_number": "218-463-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 MAIN AVE N",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511820",
            "telephone_number": "218-463-2020",
            "fax_number": "218-463-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "DEVAUGHN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "13951ER",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Dahl
• Shivali Devgon, MD
• Annabi I Djalo, MD
• Cynthia Faye Drost-Sandy, DDS
• Tara Ellenson, MOTR/L
• Matthew Lew Erickson, D.C.
• Marianne Renae Foldesi, PA-C
• Elle Mae Frislie, RN
• Jennifer Lynn Galbraith, MS, LMFT
• Larayne Lamae Gjovik, LPN

• Optometrist in Roseau, MN
• Providers in Roseau, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.