Provider Demographics
NPI:1841321809
Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Entity type:Organization
Organization Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-236-1770
Mailing Address - Street 1:6557 BRANDT PK
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424
Mailing Address - Country:US
Mailing Address - Phone:937-236-1770
Mailing Address - Fax:
Practice Address - Street 1:6557 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3353
Practice Address - Country:US
Practice Address - Phone:937-236-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9929502Medicare PIN
OH0310550001Medicare NSC