Individual
MARK EISENBREI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 30TH ST NW, CANTON, OH 44709-2921
(330) 492-0038
(330) 492-2914
Mailing address
1130 30TH ST NW, CANTON, OH 44709-2921
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SC 2290
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2621434
—
OH
Enumeration date
08/26/2014
Last updated
08/26/2014
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