Provider Demographics
NPI:1033103213
Name:SLAGLE, AMBER MIDDLETON (OD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:MIDDLETON
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 TANYARD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1531
Mailing Address - Country:US
Mailing Address - Phone:540-483-5256
Mailing Address - Fax:540-483-7050
Practice Address - Street 1:365 TANYARD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1531
Practice Address - Country:US
Practice Address - Phone:540-483-5256
Practice Address - Fax:540-483-7050
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00V306A71Medicare ID - Type Unspecified
U78853Medicare UPIN