Provider Demographics
NPI:1265679542
Name:EICHELBERGER, EVON Y (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:EVON
Middle Name:Y
Last Name:EICHELBERGER
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 BEAR VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2200
Mailing Address - Country:US
Mailing Address - Phone:803-321-0715
Mailing Address - Fax:803-321-0718
Practice Address - Street 1:2024 BEAR VILLAGE CT
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2200
Practice Address - Country:US
Practice Address - Phone:803-321-0715
Practice Address - Fax:803-321-0718
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC851156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician