Provider Demographics
NPI:1285601195
Name:SLAVIN, ROBERT D (OD, INC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:OD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-0648
Mailing Address - Country:US
Mailing Address - Phone:405-247-6412
Mailing Address - Fax:405-247-7129
Practice Address - Street 1:122 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-2806
Practice Address - Country:US
Practice Address - Phone:405-247-6412
Practice Address - Fax:405-247-7129
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761900AMedicaid
OK100761900AMedicaid
OK0170610001Medicare NSC