Healthcare Provider Details

I. General information

NPI: 1427047273
Provider Name (Legal Business Name): MICHAEL A EGGER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 LINN AVE
OREGON CITY OR
97045-3634
US

IV. Provider business mailing address

1103 LINN AVE
OREGON CITY OR
97045-3634
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-2522
  • Fax: 503-655-0300
Mailing address:
  • Phone: 503-655-2522
  • Fax: 503-655-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1340AT
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier144170
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: