Provider Demographics
NPI:1629090683
Name:EISNER, LESLIE ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ALLAN
Last Name:EISNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:STE 370
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4265
Practice Address - Country:US
Practice Address - Phone:480-563-8787
Practice Address - Fax:480-563-2377
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025474207W00000X
AZ34169207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT18000267Medicare ID - Type UnspecifiedFIRST COAST SERVICES
AZ104512Medicare ID - Type Unspecified
B84143Medicare UPIN