MEDICARE: DAVID EISENACH

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	231H00000X	Audiologist	51513	TX

General Provider Information

NPI Number	:	1902990856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EISENACH

Provider Business Mailing Address
First Line	:	301 FISHER ST
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39534-2508
Country	:	US
Telephone Number	:	222-820-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	72D MDG
Second Line	:	7050 AIR DEPOT BLVD
City	:	TINKER AIR FORCE BASE
State	:	OK
Zip	:	73145
Country	:	US
Telephone Number	:	757-713-7895
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/15/2025

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