Healthcare Provider Details

I. General information

NPI: 1285679464
Provider Name (Legal Business Name): ROBERT D SLOAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N WASHINGTON ST.
CHILLICOTHEE MO
64601
US

IV. Provider business mailing address

1115 N WASHINGTON ST.
CHILLICOTHEE MO
64601
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-3937
  • Fax: 660-646-4092
Mailing address:
  • Phone: 660-646-3937
  • Fax: 660-646-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02343
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: