MEDICARE: ROBERT M EASTON JR. OD

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	OPC 1736	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC 1736	FL
3	152WP0200X	Pediatric Optometrist	OPC 1736	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0PC 1736	OTHER	FL	FL BOARD CERTIFICATION #

General Provider Information

NPI Number	:	1134121247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M EASTON JR. OD

Provider Business Mailing Address
First Line	:	1560 E OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-4425
Country	:	US
Telephone Number	:	954-564-2025
Fax Number	:	954-564-3869

Provider Business Practice Location Address
First Line	:	1560 E OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-4425
Country	:	US
Telephone Number	:	954-564-2025
Fax Number	:	954-564-3869

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/17/2008

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