=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871715029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE FAMILY EYECARE AND OPTIQUE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136 SECOND AVE
-----------------------------------------------------
City | COLLEGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-489-7800
-----------------------------------------------------
Fax | 610-489-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 SECOND AVE
-----------------------------------------------------
City | COLLEGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-489-7800
-----------------------------------------------------
Fax | 610-489-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNERDOCTOR
-----------------------------------------------------
Name | DR. JOHN F SLOAT
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 610-489-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OE7323T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------