Provider Demographics
NPI:1689084113
Name:SLEZAK, AMBER N (OD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:N
Last Name:SLEZAK
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 1:180 E BROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7573
Mailing Address - Country:US
Mailing Address - Phone:740-927-3061
Mailing Address - Fax:740-927-7042
Practice Address - Street 1:180 E BROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7573
Practice Address - Country:US
Practice Address - Phone:740-927-3061
Practice Address - Fax:740-927-7042
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist