Provider Demographics
NPI:1447207949
Name:SLAUGHTER, KIMBERLEE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:MARIE
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLEE
Other - Middle Name:MARIE
Other - Last Name:MAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3419 EL SALIDO PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5639
Mailing Address - Country:US
Mailing Address - Phone:512-918-3937
Mailing Address - Fax:512-918-2028
Practice Address - Street 1:3419 EL SALIDO PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5634
Practice Address - Country:US
Practice Address - Phone:512-918-3937
Practice Address - Fax:512-918-2028
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6407TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6407TGOtherOPTOMETRY
TX6407TGOtherOPTOMETRY
TXMM1035131OtherDEA LICENSE
TXU98910Medicare UPIN