=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063122836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLOTWINSKI EYECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2022
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3640 MUNDY MILL RD STE 146
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30504-8201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-290-8182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5524 BRENDLYNN DR
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-7553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-269-0760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER SLOTWINSKI
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 630-269-0760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------