Provider Demographics
NPI:1558576629
Name:EGER, JEFFREY JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOEL
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 1:1106 W UNIVERSITY DR # 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5532
Mailing Address - Country:US
Mailing Address - Phone:480-964-6672
Mailing Address - Fax:
Practice Address - Street 1:1106 W UNIVERSITY DR # 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5532
Practice Address - Country:US
Practice Address - Phone:480-964-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51152W00000X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ19127OtherSPECTERA
AZ25754OtherAVESIS
AZAZ0051OtherEYEMED
AZ25754OtherAVESIS