Provider Demographics
NPI:1720070030
Name:EATON, G. LOGAN (OD)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:LOGAN
Last Name:EATON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1711
Mailing Address - Country:US
Mailing Address - Phone:781-878-2020
Mailing Address - Fax:781-878-5643
Practice Address - Street 1:127 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1711
Practice Address - Country:US
Practice Address - Phone:781-878-2020
Practice Address - Fax:781-878-5643
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist