Provider Demographics
NPI:1447639349
Name:EATON EYECARE OF GRANBY
Entity type:Organization
Organization Name:EATON EYECARE OF GRANBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:EATON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:860-951-6582
Mailing Address - Street 1:71 JOHN OLDS DR APT 208
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8794
Mailing Address - Country:US
Mailing Address - Phone:860-951-6582
Mailing Address - Fax:
Practice Address - Street 1:16 E GRANBY RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2201
Practice Address - Country:US
Practice Address - Phone:860-653-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty