Provider Demographics
NPI:1952373383
Name:ECKHARDT, TINA J (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:J
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:J
Other - Last Name:ANANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:777 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1650
Practice Address - Country:US
Practice Address - Phone:563-323-2020
Practice Address - Fax:563-328-5694
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32758207W00000X
IL036088865207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0060350OtherIA GROUP MEDICAID
IA0188110Medicaid
IA09382OtherIA BCBS
IA26568OtherIA GROUP MEDICARE
IL790730OtherIL GROUP MEDICARE
IA09382OtherIA BCBS
IA26568OtherIA GROUP MEDICARE
G34125Medicare UPIN