Provider Demographics
NPI:1487657912
Name:EISCHENS, GEORGE NICHOLAS (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NICHOLAS
Last Name:EISCHENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JASMINE TRL
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-3661
Mailing Address - Country:US
Mailing Address - Phone:334-365-2020
Mailing Address - Fax:334-365-4845
Practice Address - Street 1:605 JASMINE TRL
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-3661
Practice Address - Country:US
Practice Address - Phone:334-365-2020
Practice Address - Fax:334-365-4845
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS983TA555152WC0802X, 152WL0500X
ALS-983-TA-555152WV0400X
ALS-983-TA 555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51509621OtherBLUE CROSS BLUE SHELD NUM
AL051509621Medicaid
AL051509621Medicaid
U86988Medicare UPIN