Provider Demographics
NPI:1659608263
Name:EGGERS, JILL (OD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:EGGERS
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 1:9709 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-3019
Mailing Address - Country:US
Mailing Address - Phone:515-231-5914
Mailing Address - Fax:
Practice Address - Street 1:2157 SE LA GRANT PKWY
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-7605
Practice Address - Country:US
Practice Address - Phone:515-534-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2767152W00000X
IA002477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist