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General NPI Number Information
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NPI Number | 1699702977
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Entity Type | Individual
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Provider Name | EDWARD ALLEN EISENMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 1230 HARRISON ST
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City | OAKLAND
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State | CA
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Zip | 94612-3913
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Country | US
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Telephone | 510-839-0938
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Fax | 510-839-1818
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Provider Business Mailing Address
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Address Line | 20881 WILBEAM AVE APT. # 22
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5807
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Country | US
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Telephone | 510-583-0260
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT 9237 TPA
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License Number State | CA
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