Healthcare Provider Details

I. General information

NPI: 1285601195
Provider Name (Legal Business Name): ROBERT D SLAVIN OD, INC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W BROADWAY ST
ANADARKO OK
73005-2806
US

IV. Provider business mailing address

PO BOX 648
ANADARKO OK
73005-0648
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-6412
  • Fax: 405-247-7129
Mailing address:
  • Phone: 405-247-6412
  • Fax: 405-247-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number797
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: