Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC 1736 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC 1736 | FL |
N | 152WP0200X | Pediatric Optomitrist | OPC 1736 | FL |
NPI | 1134121247 |
---|---|
Provider Name | Robert M Easton JR. |
First Address | Oakland Park, FL 33334-4425 |
Second Address | Oakland Park, FL 33334-4425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 17/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PC 1736 | FL BOARD CERTIFICATION # (01) | FL |
T84180 | (02) | FL |