Individual
SUSAN LYNN EGGEBRECHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
7750 W JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 459-9595
(260) 459-9494
Mailing address
7750 W JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 459-9595
(260) 459-9494
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002378A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100464730
—
IN
Enumeration date
01/31/2006
Last updated
03/13/2014
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