Provider Demographics
NPI:1174649743
Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Entity Type:Organization
Organization Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Other - Org Name:GEMINI EYE CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-236-1770
Mailing Address - Street 1:2418 ESQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4203
Mailing Address - Country:US
Mailing Address - Phone:937-429-3010
Mailing Address - Fax:937-429-3307
Practice Address - Street 1:2418 ESQUIRE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4203
Practice Address - Country:US
Practice Address - Phone:937-429-3010
Practice Address - Fax:937-429-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9929503Medicare PIN
OH0310550003Medicare NSC