Healthcare Provider Details

I. General information

NPI: 1043219207
Provider Name (Legal Business Name): DEBRA JANE SLEIGHT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MAIN ST
MARLBORO MA
01752-3803
US

IV. Provider business mailing address

103 MAIN ST
MARLBORO MA
01752-3803
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-4900
  • Fax:
Mailing address:
  • Phone: 508-481-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3885
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: