Provider Demographics
NPI:1932459419
Name:ROBERT M EASTON JR OD PA
Entity Type:Organization
Organization Name:ROBERT M EASTON JR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MORRELL
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:954-564-2025
Mailing Address - Street 1:1560 EAST 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 EAST 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001736152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL289OtherAMERICAN BOARD OF OPTOMETRY
FLOPC001736OtherFLORIDA BOARD CERTIFIED OPTOMETRIST
FLT84180Medicare UPIN
FL19181Medicare PIN