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General NPI Number Information
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NPI Number | 1689054629
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Entity Type | Individual
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Provider Name | MARY LAUREN EATON O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9600 SOUTH IH 35 SB S#225
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City | AUSTIN
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State | TX
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Zip | 78748
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Country | US
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Telephone | 512-291-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 SOUTH IH 35 SB S#225
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City | AUSTIN
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State | TX
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Zip | 78748
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Country | US
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Telephone | 512-291-0876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1836-770AT
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2844
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9068TG
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License Number State | TX
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