Provider Demographics
NPI:1013041912
Name:EGGERT & EGGERT LLC
Entity Type:Organization
Organization Name:EGGERT & EGGERT LLC
Other - Org Name:EGGERT FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-686-1000
Mailing Address - Street 1:707 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1717
Mailing Address - Country:US
Mailing Address - Phone:920-894-2020
Mailing Address - Fax:920-894-2027
Practice Address - Street 1:707 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1717
Practice Address - Country:US
Practice Address - Phone:920-894-2020
Practice Address - Fax:920-894-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000047685Medicare PIN