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General NPI Number Information
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NPI Number | 1245517804
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Entity Type | Organization
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Legal Business Name | RUSSELL R SLAUGH OD AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 56970 YUCCA TRL STE 101
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7910
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Country | US
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Telephone | 760-228-2020
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Fax | 760-369-2020
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Provider Business Mailing Address
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Address Line | 56970 YUCCA TRL STE 101
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7910
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Country | US
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Telephone | 760-228-2020
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Fax | 760-369-2020
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | RUSSELL R SLAUGH
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Credential | O.D.
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Telephone | 760-228-2020
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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 | 14240
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License Number State | CA
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