Provider Demographics
NPI:1548572472
Name:EIGENBERG, ANDREA (OD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:EIGENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 PARK LANE DR APT 10
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3428
Mailing Address - Country:US
Mailing Address - Phone:402-570-9036
Mailing Address - Fax:
Practice Address - Street 1:110 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1971
Practice Address - Country:US
Practice Address - Phone:308-832-0144
Practice Address - Fax:308-832-0737
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist