Provider Demographics
NPI:1437193554
Name:EIGENBRODT VISION CENTER, P.C.
Entity Type:Organization
Organization Name:EIGENBRODT VISION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:EIGENBRODT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-656-3199
Mailing Address - Street 1:1950 EDWARDSVILLE CLUB PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3717
Mailing Address - Country:US
Mailing Address - Phone:618-656-3199
Mailing Address - Fax:618-656-3099
Practice Address - Street 1:1950 EDWARDSVILLE CLUB PLAZA
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3717
Practice Address - Country:US
Practice Address - Phone:618-656-3199
Practice Address - Fax:618-656-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL274260OtherGHP
ILDG3297OtherPALMETTOGBA/RROADMED.
IL5932266OtherAETNA
IL400311OtherGROUP HEALTH PLAN
IL901900OtherMEDICARE
IL125419OtherBLUE CROSS BLUE SHIELD MO
IL125215OtherHEALTHLINK
IL06032220OtherBLUE CROSS BLUE SHIELD IL
IL115544OtherEYEMED
ILDG3297OtherPALMETTOGBA/RROADMED.
IL115544OtherEYEMED