Healthcare Provider Details

I. General information

NPI: 1053562397
Provider Name (Legal Business Name): EASTON OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MARLBORO AVE STE 31
EASTON MD
21601-2767
US

IV. Provider business mailing address

210 MARLBORO AVE STE 31
EASTON MD
21601-2767
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-3937
  • Fax: 410-822-2652
Mailing address:
  • Phone: 410-822-3937
  • Fax: 410-822-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. ALAN SCOTT BISHOP
Title or Position: OWNER
Credential: O.D.
Phone: 410-822-3937