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General NPI Number Information
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NPI Number | 1487772067
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Entity Type | Individual
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Provider Name | CYNTHIA BULLARD SLATON O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1313 N FRY RD STE A
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City | KATY
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State | TX
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Zip | 77449-3343
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Country | US
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Telephone | 281-579-6939
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Fax | 281-579-2714
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Provider Business Mailing Address
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Address Line | 123 SIBELIUS LN
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City | HOUSTON
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State | TX
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Zip | 77079-7203
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Country | US
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Telephone | 713-973-6233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4709T
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License Number State | TX
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