Provider Demographics
NPI:1780803643
Name:EASTON OPTICAL LLC
Entity type:Organization
Organization Name:EASTON OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-822-3937
Mailing Address - Street 1:210 MARLBORO AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2765
Mailing Address - Country:US
Mailing Address - Phone:410-822-3937
Mailing Address - Fax:
Practice Address - Street 1:401 RACE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1835
Practice Address - Country:US
Practice Address - Phone:410-228-0500
Practice Address - Fax:410-822-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418419000Medicaid
MD418419000Medicaid