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General NPI Number Information
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NPI Number | 1447639349
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Entity Type | Organization
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Legal Business Name | EATON EYECARE OF GRANBY
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 16 E GRANBY RD
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City | GRANBY
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State | CT
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Zip | 06035-2201
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Country | US
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Telephone | 860-653-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 71 JOHN OLDS DR APT 208
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City | MANCHESTER
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State | CT
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Zip | 06042-8794
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Country | US
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Telephone | 860-951-6582
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DAVID EARL EATON JR.
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Credential | O.D.
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Telephone | 860-951-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2878
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License Number State | CT
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