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General NPI Number Information
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NPI Number | 1144318627
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Entity Type | Organization
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Legal Business Name | SLH OPTICAL, INC.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3300 CHAMBERS RD SUITE 5086
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City | HORSEHEADS
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State | NY
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Zip | 14845-1404
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Country | US
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Telephone | 607-739-0383
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Fax | 607-739-5362
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Provider Business Mailing Address
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Address Line | 3300 CHAMBERS RD SUITE 5086
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City | HORSEHEADS
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State | NY
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Zip | 14845-1404
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Country | US
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Telephone | 607-739-0383
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Fax | 607-739-5362
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHELDON L. HALLSTROM
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Credential | O.D.
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Telephone | 607-739-0383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV004363-1
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License Number State | NY
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