Provider Demographics
NPI:1184975419
Name:ECKHART, ELIZABETH M (O D)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:ECKHART
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GREEN ST
Mailing Address - Street 2:APT C
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2867
Mailing Address - Country:US
Mailing Address - Phone:937-902-1667
Mailing Address - Fax:
Practice Address - Street 1:6557 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3353
Practice Address - Country:US
Practice Address - Phone:937-236-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist