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NPI Code Detail

MEDICARE: DR. JIMMY N EATON O.D.

MEDICARE: DR. JIMMY N 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
1152W00000XOptometrist887-122TLA

General Provider Information

NPI Number : 1942380985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JIMMY N EATON O.D.
Provider Business Mailing Address
First Line : 911 TECH DR
Second Line :
City : RUSTON
State : LA
Zip : 71270-0701
Country : US
Telephone Number : 318-251-9095
Fax Number :
Provider Business Practice Location Address
First Line : 911 TECH DR
Second Line :
City : RUSTON
State : LA
Zip : 71270-0701
Country : US
Telephone Number : 318-251-9095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/11/2014

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