MEDICARE: DR. G. LOGAN EATON 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	2250	MA

General Provider Information

NPI Number	:	1720070030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. G. LOGAN EATON O.D.

Provider Business Mailing Address
First Line	:	127 WASHINGTON ST
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1711
Country	:	US
Telephone Number	:	781-878-2020
Fax Number	:	781-878-5643

Provider Business Practice Location Address
First Line	:	127 WASHINGTON ST
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1711
Country	:	US
Telephone Number	:	781-878-2020
Fax Number	:	781-878-5643

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/16/2016

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