Provider Demographics
NPI:1023007317
Name:EICHENBAUM, BARRY A (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:EICHENBAUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5404
Mailing Address - Country:US
Mailing Address - Phone:305-444-8331
Mailing Address - Fax:305-443-6116
Practice Address - Street 1:58 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5404
Practice Address - Country:US
Practice Address - Phone:305-444-8331
Practice Address - Fax:305-443-6116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U05979Medicare UPIN
19590Medicare ID - Type Unspecified