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NPI Code Detail

MEDICARE: SHAWN M SLATTERY

MEDICARE: SHAWN M SLATTERY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC002390FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306935705
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN M SLATTERY
Provider Business Mailing Address
First Line : 403 E 11TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-3409
Country : US
Telephone Number : 850-747-5599
Fax Number :
Provider Business Practice Location Address
First Line : 2235 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-6023
Country : US
Telephone Number : 850-747-5272
Fax Number : 850-747-5274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 04/10/2026

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Directions to “ SHAWN M SLATTERY ” Practice Location

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