Healthcare Provider Details

I. General information

NPI: 1447358528
Provider Name (Legal Business Name): DAMON EGGERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W DIVISION ST SUITE 90
SAINT CLOUD MN
56301-6601
US

IV. Provider business mailing address

11103 WEST AVE SUITE 6
SAN ANTONIO TX
78213-1370
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-1131
  • Fax: 320-259-9394
Mailing address:
  • Phone: 210-524-6663
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3049
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: