Provider Demographics
NPI:1780639351
Name:EASTON, JAIME RENAE (OD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:RENAE
Last Name:EASTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 GALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 FIVE SPRINGS RD STE G1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-8756
Practice Address - Country:US
Practice Address - Phone:434-207-4040
Practice Address - Fax:844-526-2650
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010286042Medicaid
VAP00366761OtherPALMETTO RR MEDICARE
VA206283OtherANTHEM
VAV10738Medicare UPIN
VAP00366761OtherPALMETTO RR MEDICARE