Healthcare Provider Details

I. General information

NPI: 1366280521
Provider Name (Legal Business Name): VANESSA ROSE EGER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E MONTAUK HWY STE 29
EAST PATCHOGUE NY
11772-3154
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 631-576-4499
  • Fax: 631-576-4253
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: