Provider Demographics
NPI:1144251356
Name:EICHENBAUM, DAVID AARON (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AARON
Last Name:EICHENBAUM
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 1:4344 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1141
Mailing Address - Country:US
Mailing Address - Phone:727-323-0077
Mailing Address - Fax:727-323-7627
Practice Address - Street 1:4344 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1141
Practice Address - Country:US
Practice Address - Phone:727-323-0077
Practice Address - Fax:727-323-7627
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90466207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00456168OtherRAILROAD MEDICARE
FL279428400Medicaid
FL279428400Medicaid
FLAH080ZMedicare PIN
FLAH080YMedicare PIN
FLI33647Medicare UPIN