Healthcare Provider Details

I. General information

NPI: 1679839690
Provider Name (Legal Business Name): JANICE E EGGERT MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E FLAMINGO RD STE 214A
LAS VEGAS NV
89119-0850
US

IV. Provider business mailing address

1771 E FLAMINGO RD STE 214A
LAS VEGAS NV
89119-0850
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-5252
  • Fax: 702-737-5960
Mailing address:
  • Phone: 702-737-5252
  • Fax: 702-737-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JANICE E EGGERT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-737-5252