Alice Audrey Eaton, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD16709 Issued in OR

Practice address

3434 12TH Ave NE
Olympia, WA 98506-5175

Phone

(360) 413-8364

Fax

(360) 413-8491

NPI assigned

May 1, 2006

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Westside Pediatric Clinic PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1093929226
  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1255399333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8079 SW SACAJAWEA WAY",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970706428",
            "telephone_number": "503-784-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 12TH AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065175",
            "telephone_number": "360-413-8364",
            "fax_number": "360-413-8491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9555 SW Barnes Rd Ste 270",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256613",
            "country_code": "US",
            "telephone_number": "503-297-1025",
            "fax_number": "503-297-1043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EATON",
        "first_name": "ALICE",
        "middle_name": "AUDREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-01",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD 00030157",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "WA",
            "license": "MD 00030157",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD16709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036181",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI WEST",
            "identifier": "93112982997006A008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLAN",
            "identifier": "F15106",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "021993008",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tarah Jade Earhart, LMHC
• Shelley S Earing, MPT OCS
• Taylor Easley
• Jenae Eastman, MC
• Eastside Urgent Care Dentistry (Eastside Emergency Dentistry)
• Jeremy Joseph Eaton, DO
• Evelyn Ebarle Ebalo, M.D.
• Karol Kay Prosser Ebio, LMFT
• Michael John Eby
• Leesa Catharine Echols, MD

• Pediatrics Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.