Healthcare Provider Details

I. General information

NPI: 1295823565
Provider Name (Legal Business Name): RICHARD SAMUEL EISENBERG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21835 1/2 VENTURA BLVD
WOODLAND HILLS CA
91364-1864
US

IV. Provider business mailing address

21835 1/2 VENTURA BLVD
WOODLAND HILLS CA
91364-1864
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-9562
  • Fax:
Mailing address:
  • Phone: 818-883-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5846T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: