Provider Demographics
NPI:1639189442
Name:EGGERT & EGGERT LLC
Entity Type:Organization
Organization Name:EGGERT & EGGERT LLC
Other - Org Name:THE EYECARE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OD
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-686-1000
Mailing Address - Street 1:550 N MILITARY AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4569
Mailing Address - Country:US
Mailing Address - Phone:920-498-2020
Mailing Address - Fax:920-498-2269
Practice Address - Street 1:550 N MILITARY AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4569
Practice Address - Country:US
Practice Address - Phone:920-498-2020
Practice Address - Fax:920-498-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6517120001Medicare NSC
WI000087970Medicare ID - Type Unspecified
WI1282330001Medicare NSC