Healthcare Provider Details

I. General information

NPI: 1548254733
Provider Name (Legal Business Name): AMBER SLAGLE OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 TANYARD RD
ROCKY MOUNT VA
24151-1531
US

IV. Provider business mailing address

365 TANYARD RD
ROCKY MOUNT VA
24151-1531
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-5256
  • Fax: 540-483-7050
Mailing address:
  • Phone: 540-483-5256
  • Fax: 540-483-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMBER MIDDLETON SLAGLE
Title or Position: OPTOMETRIST PRESIDENT OWNER
Credential: OD
Phone: 540-483-5256