Healthcare Provider Details

I. General information

NPI: 1932459419
Provider Name (Legal Business Name): ROBERT M EASTON JR OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 EAST OAKLAND PARK BLVD
OAKLAND PARK FL
33334-4425
US

IV. Provider business mailing address

1560 EAST OAKLAND PARK BLVD
OAKLAND PARK FL
33334-4425
US

V. Phone/Fax

Practice location:
  • Phone: 954-564-2025
  • Fax: 954-564-3869
Mailing address:
  • Phone: 954-564-2025
  • Fax: 954-564-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC001736
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC001736
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT MORRELL EASTON JR.
Title or Position: OPTOMETRIC PHYSICIAN
Credential: O.D., F.A.A.O.
Phone: 954-564-2025