Provider Demographics
NPI:1518937606
Name:EGER, MARK W (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:EGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2051
Mailing Address - Country:US
Mailing Address - Phone:412-264-8830
Mailing Address - Fax:412-269-7766
Practice Address - Street 1:1501 STATE AVE
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2051
Practice Address - Country:US
Practice Address - Phone:412-264-8830
Practice Address - Fax:412-269-7766
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01802747Medicaid
U07969Medicare UPIN
410040339Medicare PIN
PA286491NL8Medicare PIN