Basic Information
| Provider Information | |||||||||
| NPI: | 1457342685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EIDEN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | BARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 S WAUKEGAN RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DEERFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600155654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474120311 | ||||||||
| FaxNumber: | 8474120316 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 S WAUKEGAN RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DEERFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600155654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474120311 | ||||||||
| FaxNumber: | 8474120316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2005 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046007419 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.