Provider Demographics
NPI:1306962980
Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Entity type:Organization
Organization Name:DR. JAMES D. EGBERT, OPTOMETRIST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:YEAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-236-1770
Mailing Address - Street 1:8118 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3786
Mailing Address - Country:US
Mailing Address - Phone:937-433-9868
Mailing Address - Fax:937-433-8264
Practice Address - Street 1:8118 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3786
Practice Address - Country:US
Practice Address - Phone:937-433-9868
Practice Address - Fax:937-433-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9929501Medicare PIN
OH0310550004Medicare NSC