Provider Demographics
NPI:1699702977
Name:EISENMAN, EDWARD ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:EISENMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20881 WILBEAM AVE
Mailing Address - Street 2:APT. # 22
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5807
Mailing Address - Country:US
Mailing Address - Phone:510-583-0260
Mailing Address - Fax:
Practice Address - Street 1:1230 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3913
Practice Address - Country:US
Practice Address - Phone:510-839-0938
Practice Address - Fax:510-839-1818
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 9237 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0092371Medicare PIN