MEDICARE: DR. JOHN BOWEN EASTLAKE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	60970317	WA

General Provider Information

NPI Number	:	1134119068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BOWEN EASTLAKE O.D.

Provider Business Mailing Address
First Line	:	MADIGAN ARMY MEDICAL CENTER
Second Line	:	9040 JACKSON AVE
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98431
Country	:	US
Telephone Number	:	253-968-3760
Fax Number	:

Provider Business Practice Location Address
First Line	:	MADIGAN ARMY MEDICAL CENTER
Second Line	:	9040 JACKSON AVE
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98431
Country	:	US
Telephone Number	:	253-968-3760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2005
Last Update Date	:	01/21/2021

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