Healthcare Provider Details

I. General information

NPI: 1639189442
Provider Name (Legal Business Name): EGGERT & EGGERT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MILITARY AVE SUITE 10
GREEN BAY WI
54303-4569
US

IV. Provider business mailing address

550 N MILITARY AVE SUITE 10
GREEN BAY WI
54303-4569
US

V. Phone/Fax

Practice location:
  • Phone: 920-498-2020
  • Fax: 920-498-2269
Mailing address:
  • Phone: 920-498-2020
  • Fax: 920-498-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2292
License Number StateWI

VIII. Authorized Official

Name: STEVEN D EGGERT
Title or Position: OWNER, OD
Credential: OD
Phone: 920-686-1000