Provider Demographics
NPI:1558426346
Name:EISS, STEWART
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:EISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 STRICKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6409
Mailing Address - Country:US
Mailing Address - Phone:718-209-1435
Mailing Address - Fax:718-968-1448
Practice Address - Street 1:6175 STRICKLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6409
Practice Address - Country:US
Practice Address - Phone:718-209-1435
Practice Address - Fax:718-968-1448
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY4214156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0860780001Medicare PIN