John Bowen Eastlake, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

60970317 Issued in WA

Practice address

Madigan Army Medical Center
9040 Jackson Ave
Joint Base Lewis McChord, WA 98431

Phone

(253) 968-3760

NPI assigned

Oct 23, 2005

Last updated

Jan 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1134119068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER",
            "address_2": "9040 JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "253-968-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER",
            "address_2": "9040 JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "253-968-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASTLAKE",
        "first_name": "JOHN",
        "middle_name": "BOWEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-23",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60970317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichelle Duncan, PH.D.
• Richard Murray Durbin
• Taylor R Dusa, RN
• Laksha Dutt, DPM
• Rachel Nell Dyal
• Gina Liane Eberhardt, ARNP, AGCNS-BC
• Katelynn Blume Eberle, PHARMD
• Matthew Joseph Eckert, MD
• Jillian Nicole Eichelkraut
• Brody Jules Elliott

• Optometrist in Joint Base Lewis McChord, WA
• Providers in Joint Base Lewis McChord, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.