Healthcare Provider Details

I. General information

NPI: 1902017965
Provider Name (Legal Business Name): SAMANTHA SLOTNICK OD, FAAO, FCOVD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CENTRAL PARK AVE STE 301
SCARSDALE NY
10583-1038
US

IV. Provider business mailing address

23 OLD MAMARONECK RD APT 4L
WHITE PLAINS NY
10605-2013
US

V. Phone/Fax

Practice location:
  • Phone: 914-874-1118
  • Fax: 914-885-1463
Mailing address:
  • Phone: 914-874-1118
  • Fax: 914-885-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00597800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV006820
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV006820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: