Eigenbrodt Vision Center, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008144 Issued in IL

Legal business name

EIGENBRODT VISION CENTER, P.C.

Practice address

1950 Edwardsville Club Plaza
Edwardsville, IL 62025-3717

Phone

(618) 656-3199

Fax

(618) 656-3099

NPI assigned

Jun 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Robert Eigenbrodt, O.D.

Title

President

Phone

(618) 656-3199

Specialties & licenses 1

Addresses

Other identifiers 9

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1437193554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 EDWARDSVILLE CLUB PLAZA CT",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253717",
            "telephone_number": "618-656-3199",
            "fax_number": "618-656-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 EDWARDSVILLE CLUB PLAZA",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253717",
            "telephone_number": "618-656-3199",
            "fax_number": "618-656-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EIGENBRODT VISION CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "EIGENBRODT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-656-3199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "274260",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTOGBA/RROADMED.",
            "identifier": "DG3297",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5932266",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "400311",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "901900",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MO",
            "identifier": "125419",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "125215",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "06032220",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "115544",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edwardsville Healthcare Center Investors, LLC
• Edwardsville NH LLC
• Edwardsville Nursing and Rehab Center LLC
• Edwardsville Physicians Group LLC
• Rebecca Eggering
• John Robert Eigenbrodt, O.D.
• Meagan Eilers
• Elfatih Eisa
• Morgan Nicole Ekstrom, OTD, OTR/L
• Brianna Susan Ellis

• Optometrist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.