Healthcare Provider Details

I. General information

NPI: 1588686935
Provider Name (Legal Business Name): STEVEN D EGGERT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARK AVENUE
KIEL WI
53042-1717
US

IV. Provider business mailing address

707 PARK AVENUE
KIEL WI
53042-1717
US

V. Phone/Fax

Practice location:
  • Phone: 920-498-2020
  • Fax: 920-894-2027
Mailing address:
  • Phone: 920-498-2020
  • Fax: 920-894-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: