MEDICARE: MRS. KELLY A SLIFER OD

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
1	152W00000X	Optometrist	3687TG	TX
2	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1376534248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY A SLIFER OD

Provider Business Mailing Address
First Line	:	3810 S COOPER ST
Second Line	:	STE 120
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4149
Country	:	US
Telephone Number	:	817-557-3952
Fax Number	:	817-557-1030

Provider Business Practice Location Address
First Line	:	3810 S COOPER ST
Second Line	:	STE 120
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4149
Country	:	US
Telephone Number	:	817-557-3952
Fax Number	:	817-557-1030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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