Provider Demographics
NPI:1992706196
Name:EICHENBAUM, DANIEL MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:EICHENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3361
Mailing Address - Country:US
Mailing Address - Phone:828-837-5404
Mailing Address - Fax:828-837-5621
Practice Address - Street 1:1321 W US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3361
Practice Address - Country:US
Practice Address - Phone:828-837-5404
Practice Address - Fax:828-837-5621
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28854207W00000X
GA036372207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00380751BMedicaid
NC30252OtherBLUE CROSS BLUE SHIELD
NC8930252Medicaid
NC30252OtherBLUE CROSS BLUE SHIELD
GA00380751BMedicaid
NC8930252Medicaid