Provider Demographics
NPI:1073576013
Name:EISELMAN, ERIC J (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:EISELMAN
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 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-939-3456
Mailing Address - Fax:239-790-2432
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-939-3456
Practice Address - Fax:239-790-2432
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28555OtherBLUE CROSS BLUE SHIELD
FLU6716XOtherMEDICARE ID UNSPECIFIED
FL3704895OtherCIGNA
FL621060100Medicaid
FL7655726OtherAETNA
FLV06940Medicare UPIN
FL621060100Medicaid