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General NPI Number Information
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NPI Number | 1629090683
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Entity Type | Individual
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Provider Name | LESLIE ALLAN EISNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 20940 N TATUM BLVD SUITE 370
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City | PHOENIX
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State | AZ
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Zip | 85050-4265
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Country | US
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Telephone | 480-563-8787
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Fax | 480-563-2377
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Provider Business Mailing Address
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Address Line | 20940 N TATUM BLVD STE 370
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City | PHOENIX
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State | AZ
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Zip | 85050-7244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 025474
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 34169
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License Number State | AZ
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