Healthcare Provider Details

I. General information

NPI: 1770560807
Provider Name (Legal Business Name): W E EICHENBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM EDWARD EICHENBERGER OD

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S JEFFERSON ST
WINCHESTER TN
37398-2121
US

IV. Provider business mailing address

411 S JEFFERSON ST
WINCHESTER TN
37398-2121
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-9635
  • Fax: 931-967-6044
Mailing address:
  • Phone: 931-967-9635
  • Fax: 931-967-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number593
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: