Provider Demographics
NPI:1275526220
Name:SLATER, FREDERICK E
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:E
Last Name:SLATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S BASCOM AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2310
Mailing Address - Country:US
Mailing Address - Phone:408-377-1212
Mailing Address - Fax:408-377-3419
Practice Address - Street 1:1875 S BASCOM AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2310
Practice Address - Country:US
Practice Address - Phone:408-377-1212
Practice Address - Fax:408-377-3419
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5101T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT5101OtherCA OPTOMETRIC LIC. #
CAT5101OtherCA OPTOMETRIC LIC. #
CASD0051010Medicare PIN