Provider Demographics
NPI:1528184058
Name:SLAGLE, CHRISTY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MARIE
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 1:131 BECKS WOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3833
Mailing Address - Country:US
Mailing Address - Phone:302-303-7740
Mailing Address - Fax:302-595-3142
Practice Address - Street 1:131 BECKS WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3833
Practice Address - Country:US
Practice Address - Phone:302-303-7740
Practice Address - Fax:302-595-3142
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1762152WV0400X
DE13-0001275152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU92359Medicare UPIN
MD471M707FMedicare ID - Type Unspecified