MEDICARE: HADLY CARSON EISENBEISZ MD

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	207W00000X	Ophthalmology Physician	17538	SD

General Provider Information

NPI Number	:	1598344566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADLY CARSON EISENBEISZ MD

Provider Business Mailing Address
First Line	:	3024 TOWER RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5392
Country	:	US
Telephone Number	:	605-508-3000
Fax Number	:	605-721-8127

Provider Business Practice Location Address
First Line	:	3024 TOWER RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5392
Country	:	US
Telephone Number	:	605-791-6220
Fax Number	:	605-721-8412

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	05/06/2026

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