Provider Demographics
NPI:1508917790
Name:EATON, JUDITH M (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:EATON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAHONEY RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-1826
Mailing Address - Country:US
Mailing Address - Phone:865-435-1938
Mailing Address - Fax:
Practice Address - Street 1:3001 KNOXVILLE CENTER DR
Practice Address - Street 2:SUITE 1150
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-5044
Practice Address - Country:US
Practice Address - Phone:865-637-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61207Medicare UPIN