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General NPI Number Information
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NPI Number | 1013187814
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Entity Type | Organization
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Legal Business Name | SHAWN SLATTERY, O.D., P.A.
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 12707 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8424
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Country | US
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Telephone | 239-774-3937
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Fax | 239-774-2296
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Provider Business Mailing Address
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Address Line | 12707 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-8424
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Country | US
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Telephone | 239-774-3937
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Fax | 239-774-2296
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAWN MICHAEL SLATTERY
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Credential | O.D.
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Telephone | 239-774-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 2390
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License Number State | FL
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