Provider Demographics
NPI:1013187814
Name:SHAWN SLATTERY, O.D., P.A.
Entity Type:Organization
Organization Name:SHAWN SLATTERY, O.D., P.A.
Other - Org Name:DBA VISION ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-774-3937
Mailing Address - Street 1:12707 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8424
Mailing Address - Country:US
Mailing Address - Phone:239-774-3937
Mailing Address - Fax:239-774-2296
Practice Address - Street 1:12707 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8424
Practice Address - Country:US
Practice Address - Phone:239-774-3937
Practice Address - Fax:239-774-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3879550001Medicare NSC