Organization
EIGENBRODT VISION CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT EIGENBRODT O.D. (PRESIDENT)
(618) 656-3199
Entity
Organization
Contact information
Practice address
1950 EDWARDSVILLE CLUB PLAZA, EDWARDSVILLE, IL 62025-3717
(618) 656-3199
(618) 656-3099
Mailing address
1950 EDWARDSVILLE CLUB PLAZA CT, EDWARDSVILLE, IL 62025-3717
(618) 656-3199
(618) 656-3099
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008144
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06032220
BLUE CROSS BLUE SHIELD IL
IL
01
—
115544
EYEMED
IL
01
—
125215
HEALTHLINK
IL
01
—
125419
BLUE CROSS BLUE SHIELD MO
IL
01
—
274260
GHP
IL
01
—
400311
GROUP HEALTH PLAN
IL
01
—
5932266
AETNA
IL
01
—
901900
MEDICARE
IL
01
—
DG3297
PALMETTOGBA/RROADMED.
IL
Enumeration date
06/16/2006
Last updated
06/04/2009
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