Provider Demographics
NPI:1942477815
Name:BARRY A. EICHENBAUM OD PA
Entity Type:Organization
Organization Name:BARRY A. EICHENBAUM OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EICHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-444-8331
Mailing Address - Street 1:58 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5404
Mailing Address - Country:US
Mailing Address - Phone:305-444-8331
Mailing Address - Fax:305-443-6116
Practice Address - Street 1:58 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5404
Practice Address - Country:US
Practice Address - Phone:305-444-8331
Practice Address - Fax:305-443-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU05939Medicare UPIN