Provider Demographics
NPI:1588686935
Name:EGGERT, STEVEN D (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:EGGERT
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 1:707 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1717
Mailing Address - Country:US
Mailing Address - Phone:920-498-2020
Mailing Address - Fax:920-894-2027
Practice Address - Street 1:707 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1717
Practice Address - Country:US
Practice Address - Phone:920-498-2020
Practice Address - Fax:920-894-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1282330001Medicare NSC
WIU18839Medicare UPIN
4617600001Medicare NSC
000047685Medicare PIN