Provider Demographics
NPI:1265662712
Name:EISENBARTH, STEPHEN LANCE (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LANCE
Last Name:EISENBARTH
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 1:403 NW LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1969
Mailing Address - Country:US
Mailing Address - Phone:785-235-6550
Mailing Address - Fax:785-235-9668
Practice Address - Street 1:403 NW LYMAN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1969
Practice Address - Country:US
Practice Address - Phone:785-235-6550
Practice Address - Fax:785-235-9668
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-18
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist