Provider Demographics
NPI:1801969720
Name:MICHAEL A EGGER OD PC
Entity type:Organization
Organization Name:MICHAEL A EGGER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:EGGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-655-2522
Mailing Address - Street 1:1103 LINN AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3634
Mailing Address - Country:US
Mailing Address - Phone:503-655-2522
Mailing Address - Fax:503-655-0300
Practice Address - Street 1:1103 LINN AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3634
Practice Address - Country:US
Practice Address - Phone:503-655-2522
Practice Address - Fax:503-655-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1340ATI152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR14417-0Medicaid
OR0664940001Medicare NSC
ORT67583Medicare UPIN
OR14417-0Medicaid