1447207949 NPI number — DR. KIMBERLEE MARIE SLAUGHTER O.D.

Table of content: MS. EMILY KATHERINE METCALF (NPI 1659133205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447207949 NPI number — DR. KIMBERLEE MARIE SLAUGHTER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLAUGHTER
Provider First Name:
KIMBERLEE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAREZ
Provider Other First Name:
KIMBERLEE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447207949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 EL SALIDO PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-5639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-918-3937
Provider Business Mailing Address Fax Number:
512-918-2028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 EL SALIDO PKWY
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-918-3937
Provider Business Practice Location Address Fax Number:
512-918-2028
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6407TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6407TG . This is a "OPTOMETRY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com