Healthcare Provider Details

I. General information

NPI: 1558576629
Provider Name (Legal Business Name): JEFFREY JOEL EGER O.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/26/2007
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
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number51
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number51
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: