Provider Demographics
NPI:1134121247
Name:EASTON, ROBERT M JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:EASTON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4425
Mailing Address - Country:US
Mailing Address - Phone:954-564-2025
Mailing Address - Fax:954-564-3869
Practice Address - Street 1:1560 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4425
Practice Address - Country:US
Practice Address - Phone:954-564-2025
Practice Address - Fax:954-564-3869
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1736152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0PC 1736OtherFL BOARD CERTIFICATION #
FL0PC 1736OtherFL BOARD CERTIFICATION #
FL0479130001Medicare NSC