Provider Demographics
NPI:1457556839
Name:LEBRON, EGGIE (OD)
Entity Type:Individual
Prefix:
First Name:EGGIE
Middle Name:
Last Name:LEBRON
Suffix:
Gender:M
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:CMR 418 BOX 1963
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 29731
Practice Address - Street 2:AAFES-COLEMAN BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09086
Practice Address - Country:US
Practice Address - Phone:49621-770-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist