MEDICARE: DR. MICHAEL A SLESS O.D.

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	TA0896	MD

General Provider Information

NPI Number	:	1801839709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A SLESS O.D.

Provider Business Mailing Address
First Line	:	16940 YORK RD
Second Line	:	SUITE 200
City	:	MONKTON
State	:	MD
Zip	:	21111-1095
Country	:	US
Telephone Number	:	410-343-2409
Fax Number	:	410-343-2410

Provider Business Practice Location Address
First Line	:	16940 YORK RD
Second Line	:	SUITE 200
City	:	MONKTON
State	:	MD
Zip	:	21111-1095
Country	:	US
Telephone Number	:	410-343-2409
Fax Number	:	410-343-2410

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/01/2008

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