Provider Demographics
NPI:1104894153
Name:EICHHORST, NATHAN KARL (OD)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:KARL
Last Name:EICHHORST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1319
Mailing Address - Country:US
Mailing Address - Phone:715-635-2020
Mailing Address - Fax:715-635-2956
Practice Address - Street 1:130 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1319
Practice Address - Country:US
Practice Address - Phone:715-635-2020
Practice Address - Fax:715-635-2956
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2293035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38584900Medicaid
2200142OtherMEDICA
391818241013OtherBLUE CROSS BLUE SHIELD
U02802Medicare UPIN
WI000187390Medicare ID - Type Unspecified