Provider Demographics
NPI:1093157992
Name:SLAGLE, CHAD R (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:R
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:224 OAK KNLS S
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1731
Mailing Address - Country:US
Mailing Address - Phone:815-505-8969
Mailing Address - Fax:
Practice Address - Street 1:575 S PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2530
Practice Address - Country:US
Practice Address - Phone:815-315-9358
Practice Address - Fax:815-397-4684
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist