Provider Demographics
NPI:1982602918
Name:EIGENBRODT, JOHN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:EIGENBRODT
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 1:1950 EDWARDSVILLE CLUB PLAZA
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3517
Mailing Address - Country:US
Mailing Address - Phone:618-656-3199
Mailing Address - Fax:618-656-3099
Practice Address - Street 1:1950 EDWARDSVILLE CLUB PLAZA
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3517
Practice Address - Country:US
Practice Address - Phone:618-656-3199
Practice Address - Fax:618-656-3099
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5932266OtherAETNA
IL06032220OtherBLUE CROSS BLUE SHIELD IL
IL203722190OtherUNITED HEALTH CARE
IL203722190OtherVISION SERVICE PLAN
IL274260OtherGHP
ILIL8144OtherEYEMED
IL125215OtherHEALTHLINK
IL125419OtherANTHEM BCB SHIELD MO
ILPOO429582OtherPTAN RAIL RD MEDICARE
IL203722190OtherUNITED HEALTH CARE
IL5932266OtherAETNA
ILPOO429582OtherPTAN RAIL RD MEDICARE