Healthcare Provider Details

I. General information

NPI: 1083995708
Provider Name (Legal Business Name): JEFFREY J.EGER,OD PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W UNIVERSITY DR #1
MESA AZ
85201-5532
US

IV. Provider business mailing address

1106 W UNIVERSITY DR #1
MESA AZ
85201-5532
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-6672
  • Fax:
Mailing address:
  • Phone: 480-964-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number51
License Number StateAZ

VIII. Authorized Official

Name: DR. JEFFREY JOEL EGER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 480-964-6672