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General NPI Number Information
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NPI Number | 1811093024
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Entity Type | Individual
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Provider Name | KELLY NICOLE SLATER O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 223 COUNTY ROAD 410
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City | SOUTH POINT
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State | OH
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Zip | 45680-7901
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Country | US
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Telephone | 740-894-4023
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Fax | 740-894-4225
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Provider Business Mailing Address
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Address Line | 660 NORTH BLVD
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City | HUNTINGTON
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State | WV
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Zip | 25701-3232
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Country | US
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Telephone | 304-617-5825
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Fax | 740-894-4225
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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 | 5418/T2329
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License Number State | OH
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