MEDICARE: RODGERS L. ECKHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301090643	MI
2	207W00000X	Ophthalmology Physician	N9448	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB137298	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1063612638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODGERS L. ECKHART MD

Provider Business Mailing Address
First Line	:	2210 SAN JACINTO BLVD
Second Line	:	SUITE 1
City	:	DENTON
State	:	TX
Zip	:	76205-7527
Country	:	US
Telephone Number	:	940-382-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 SAN JACINTO BLVD
Second Line	:	SUITE 1
City	:	DENTON
State	:	TX
Zip	:	76205-7527
Country	:	US
Telephone Number	:	940-382-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	01/20/2012

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