Provider Demographics
NPI:1528009586
Name:EICHHAMMER, ROBERT WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:EICHHAMMER
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 1:128 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1645
Mailing Address - Country:US
Mailing Address - Phone:770-461-3060
Mailing Address - Fax:770-460-9348
Practice Address - Street 1:128 N PARK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1645
Practice Address - Country:US
Practice Address - Phone:770-461-3060
Practice Address - Fax:770-460-9348
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00386317CMedicaid
41ZCBVPMedicare PIN