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General NPI Number Information
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NPI Number | 1538142047
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Entity Type | Individual
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Provider Name | PATRICK J EBERT O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2001 COOLIDGE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-1378
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Country | US
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Telephone | 517-337-1668
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Fax | 517-337-1779
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Provider Business Mailing Address
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Address Line | 1005 CHARLEVOIX DR STE 100
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City | GRAND LEDGE
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State | MI
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Zip | 48837-8186
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Country | US
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Telephone | 517-337-0316
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Fax | 517-622-1205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003247
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License Number State | MI
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