Provider Demographics
NPI:1225114358
Name:EILBERT, DAVID HOWAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOWAN
Last Name:EILBERT
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 1:10095 MAIN RD
Mailing Address - Street 2:PO BOX 1419
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-298-9555
Mailing Address - Fax:631-298-9556
Practice Address - Street 1:10095 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-298-9555
Practice Address - Fax:631-298-9556
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003815152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147OtherDAVIS VISION
NY5C5538OtherHEALTHNET
NYP2127257OtherOXFORD
NYCD8711OtherRAILROAD MEDICARE
NY2871045OtherCIGNA
NY00677532Medicaid
NY3534440OtherAETNA
NY3534440OtherAETNA
NY2871045OtherCIGNA
NYU53533Medicare UPIN