Provider Demographics
NPI:1497823280
Name:EISENSTATT, GERALD A (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:EISENSTATT
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 1:857 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5704
Mailing Address - Country:US
Mailing Address - Phone:901-767-7080
Mailing Address - Fax:901-767-2020
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2910
Practice Address - Country:US
Practice Address - Phone:901-495-9900
Practice Address - Fax:901-521-1747
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595561Medicare ID - Type Unspecified
TN3595561Medicare PIN
TNT61254Medicare UPIN