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General NPI Number Information
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NPI Number | 1700912540
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Entity Type | Organization
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Legal Business Name | SAM EISNERO.D., P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 BROAD ST
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City | STAMFORD
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State | CT
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Zip | 06901-2797
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Country | US
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Telephone | 203-324-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BROAD ST
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City | STAMFORD
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State | CT
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Zip | 06901-2797
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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 | PRESIDENT
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Name | DR. SAM M EISNER
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Credential | OD
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Telephone | 203-324-3361
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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 | 848
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License Number State | CT
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