Provider Demographics
NPI:1851305593
Name:GREGG EUBANKS OD
Entity Type:Organization
Organization Name:GREGG EUBANKS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:618-253-7057
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-5229
Mailing Address - Country:US
Mailing Address - Phone:618-253-7057
Mailing Address - Fax:618-252-1632
Practice Address - Street 1:960 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-5229
Practice Address - Country:US
Practice Address - Phone:618-253-7057
Practice Address - Fax:618-252-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0185380001Medicare NSC