Provider Demographics
NPI:1851342166
Name:EISENBERG, DAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:L
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E OSBORN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2347
Mailing Address - Country:US
Mailing Address - Phone:480-994-5012
Mailing Address - Fax:480-994-9479
Practice Address - Street 1:300 E OSBORN RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2347
Practice Address - Country:US
Practice Address - Phone:480-994-5012
Practice Address - Fax:480-994-9479
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70247207W00000X
NV8717207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851342166Medicaid
NV002018018Medicaid
180033156OtherPALMETTO RAILROAD
NV002018018Medicaid