Provider Demographics
NPI:1811627326
Name:SLOAN, ANNE KATHERINE (LDO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERINE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-6070
Mailing Address - Country:US
Mailing Address - Phone:843-449-4626
Mailing Address - Fax:843-692-0409
Practice Address - Street 1:10820 KINGS RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-6070
Practice Address - Country:US
Practice Address - Phone:843-449-4626
Practice Address - Fax:843-692-0409
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1199156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician