Provider Demographics
NPI:1922847151
Name:EATON, ANTHONY JAMES LIVINGSTON
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES LIVINGSTON
Last Name:EATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4679
Mailing Address - Country:US
Mailing Address - Phone:216-456-6964
Mailing Address - Fax:
Practice Address - Street 1:4574 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4679
Practice Address - Country:US
Practice Address - Phone:216-456-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide