=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801987987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN SLOAT OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136 SECOND AVENUE
-----------------------------------------------------
City | COLLEGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-489-7800
-----------------------------------------------------
Fax | 610-489-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 SECOND AVE
-----------------------------------------------------
City | COLLEGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-489-7800
-----------------------------------------------------
Fax | 610-489-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OE007323P
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------