Provider Demographics
NPI:1417983859
Name:EISNER, LANCE P (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:P
Last Name:EISNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE
Mailing Address - Street 2:SUITE A 423
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-769-2952
Mailing Address - Fax:702-938-0189
Practice Address - Street 1:10624 S EASTERN AVE
Practice Address - Street 2:SUITE A 423
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-480-1544
Practice Address - Fax:702-714-1202
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0205213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102025Medicaid
NV002102025Medicaid
NV36846Medicare PIN