Provider Demographics
NPI:1134221252
Name:EATON, MARTIN JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:EATON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S. IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-769-7600
Mailing Address - Fax:714-866-4111
Practice Address - Street 1:222 W MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-730-9355
Practice Address - Fax:714-730-9357
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist