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General NPI Number Information
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NPI Number | 1780639351
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Entity Type | Individual
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Provider Name | JAIME RENAE EASTON O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 1200 FIVE SPRINGS RD STE G1
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-8756
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Country | US
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Telephone | 434-207-4040
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Fax | 844-526-2650
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Provider Business Mailing Address
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Address Line | 1717 GALLOWAY DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-3153
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Country | US
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Telephone |
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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 | 0618001497
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License Number State | VA
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