Provider Demographics
NPI:1477588515
Name:SLAMER, RICHARD A (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SLAMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 PATSIE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6149
Mailing Address - Country:US
Mailing Address - Phone:937-426-8920
Mailing Address - Fax:
Practice Address - Street 1:1370 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2675
Practice Address - Country:US
Practice Address - Phone:937-426-2212
Practice Address - Fax:937-426-9375
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000330231OtherANTHEM
OHU27588Medicare UPIN
OHSL0678725Medicare ID - Type Unspecified