MEDICARE: DR. SAMANTHA SLOTNICK OD, FAAO, FCOVD

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	27OA00597800	NJ
2	152WP0200X	Pediatric Optometrist	TUV006820	NY
3	152WV0400X	Vision Therapy Optometrist	TUV006820	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A300083922	OTHER		MEDICARE PTAN- PROVIDER TRANSACTION ACCESS NUMBER

General Provider Information

NPI Number	:	1902017965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA SLOTNICK OD, FAAO, FCOVD

Provider Business Mailing Address
First Line	:	23 OLD MAMARONECK RD APT 4L
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2013
Country	:	US
Telephone Number	:	914-874-1118
Fax Number	:	914-885-1463

Provider Business Practice Location Address
First Line	:	495 CENTRAL PARK AVE STE 301
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-1038
Country	:	US
Telephone Number	:	914-874-1118
Fax Number	:	914-885-1463

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/09/2015

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Directions to “ DR. SAMANTHA SLOTNICK OD, FAAO, FCOVD” Practice Location

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