Provider Demographics
NPI:1801989223
Name:EGGERT, JANICE E (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:EGGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 E FLAMINGO RD
Mailing Address - Street 2:SUITE 214A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5155
Mailing Address - Country:US
Mailing Address - Phone:702-737-5252
Mailing Address - Fax:702-737-5960
Practice Address - Street 1:1771 E FLAMINGO RD
Practice Address - Street 2:SUITE 214A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5155
Practice Address - Country:US
Practice Address - Phone:702-737-5252
Practice Address - Fax:702-737-5960
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5670207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV53860OtherMEDICARE PTAN
NV1801989223Medicaid