Provider Demographics
NPI:1679839690
Name:JANICE E EGGERT MD LTD
Entity Type:Organization
Organization Name:JANICE E EGGERT MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-737-5252
Mailing Address - Street 1:1771 E FLAMINGO RD STE 214A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0850
Mailing Address - Country:US
Mailing Address - Phone:702-737-5252
Mailing Address - Fax:702-737-5960
Practice Address - Street 1:1771 E FLAMINGO RD STE 214A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0850
Practice Address - Country:US
Practice Address - Phone:702-737-5252
Practice Address - Fax:702-737-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679839690Medicaid
NVV53859OtherMEDICARE PTAN