Provider Demographics
NPI:1801839709
Name:SLESS, MICHAEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:SLESS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:16940 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1095
Mailing Address - Country:US
Mailing Address - Phone:410-343-2409
Mailing Address - Fax:410-343-2410
Practice Address - Street 1:16940 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-1095
Practice Address - Country:US
Practice Address - Phone:410-343-2409
Practice Address - Fax:410-343-2410
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDTA0896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT77369Medicare UPIN