Provider Demographics
NPI:1821010901
Name:EGGERT, CATHERINE A (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:EGGERT
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 1:700 PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-4569
Mailing Address - Country:US
Mailing Address - Phone:920-894-2020
Mailing Address - Fax:
Practice Address - Street 1:700 PARK AVE.
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042
Practice Address - Country:US
Practice Address - Phone:920-894-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU32083Medicare UPIN