Provider Demographics
NPI:1306997259
Name:DR LESTER EISENBERG OPTOMETRIST PA
Entity type:Organization
Organization Name:DR LESTER EISENBERG OPTOMETRIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-424-9720
Mailing Address - Street 1:8000 W BROWARD BLVD
Mailing Address - Street 2:SUITE 602
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33388
Mailing Address - Country:US
Mailing Address - Phone:954-424-9720
Mailing Address - Fax:954-424-9707
Practice Address - Street 1:8000 W BROWARD BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33388
Practice Address - Country:US
Practice Address - Phone:954-424-9720
Practice Address - Fax:954-424-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20665Medicare ID - Type Unspecified
U60919Medicare UPIN