MEDICARE: DR. GEORGE NICHOLAS EISCHENS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	S983TA555	AL
2	152WL0500X	Low Vision Rehabilitation Optometrist	S983TA555	AL
3	152WV0400X	Vision Therapy Optometrist	S-983-TA-555	AL
4	152W00000X	Optometrist	S-983-TA 555	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51509621	OTHER	AL	BLUE CROSS BLUE SHELD NUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487657912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE NICHOLAS EISCHENS O.D.

Provider Business Mailing Address
First Line	:	605 JASMINE TRL
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-3661
Country	:	US
Telephone Number	:	334-365-2020
Fax Number	:	334-365-4845

Provider Business Practice Location Address
First Line	:	605 JASMINE TRL
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-3661
Country	:	US
Telephone Number	:	334-365-2020
Fax Number	:	334-365-4845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	04/18/2022

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