Provider Demographics
NPI:1902791726
Name:EASTMAN, GREYSON ALDEN (OD)
Entity type:Individual
Prefix:
First Name:GREYSON
Middle Name:ALDEN
Last Name:EASTMAN
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 1:3805 E BELL RD STE 1800
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2135
Mailing Address - Country:US
Mailing Address - Phone:602-549-2020
Mailing Address - Fax:
Practice Address - Street 1:3805 E BELL RD STE 1800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2135
Practice Address - Country:US
Practice Address - Phone:602-549-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist