Provider Demographics
NPI:1679742845
Name:DANIEL M EICHENBAUM, MD, PA
Entity Type:Organization
Organization Name:DANIEL M EICHENBAUM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-837-5404
Mailing Address - Street 1:1321 W US HIGHWAY 64
Mailing Address - Street 2:POST OFFICE BOX 39
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3361
Mailing Address - Country:US
Mailing Address - Phone:828-837-5404
Mailing Address - Fax:828-834-5621
Practice Address - Street 1:1321 W US HIGHWAY 64
Practice Address - Street 2:POST OFFICE BOX 39
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3361
Practice Address - Country:US
Practice Address - Phone:828-837-5404
Practice Address - Fax:828-834-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000028854207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00380751AMedicaid
NC8930252Medicaid
GA18BDCPGMedicare PIN
A96837Medicare UPIN
NC8930252Medicaid