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1356393623 NPI number — DAVID J SLAGOWSKI O.D.

NPI Number: 1356393623
Health Care Provider/Practitioner: DAVID J SLAGOWSKI O.D.

Information about “1356393623” NPI (DAVID J SLAGOWSKI O.D.) exists in 1356393623 in HTML format HTML  |  1356393623 in plain Text format TXT  |  1356393623 in PDF (Portable Document Format) PDF  |  1356393623 in an XML format XML  formats.

NPI Number : 1356393623 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356393623",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SLAGOWSKI",
    "FirstName": "DAVID",
    "MiddleName": "J",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1330 PRIMROSE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FOND DU LAC",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54935-1879",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-631-8529",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3499 E FAIRVIEW AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-5848",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-884-1362",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/16/2006",
    "LastUpdateDate": "11/29/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "3442-35",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "ODP-1006",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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