1063727790 NPI number — MARK A. SLOSAR O.D. PLLC

Table of content: (NPI 1063727790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063727790 NPI number — MARK A. SLOSAR O.D. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A. SLOSAR O.D. PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063727790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10608 CLARKEVILLE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-9146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-310-9926
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 N LOOP 1604 W
Provider Second Line Business Practice Location Address:
TLC, SUITE 3201
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78232-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-348-0265
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SLOSAR
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-310-9926

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7531T , 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)