Provider Demographics
NPI:1285679464
Name:SLOAN, ROBERT D (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:SLOAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:660-646-3937
Mailing Address - Fax:660-646-4092
Practice Address - Street 1:1115 N WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601
Practice Address - Country:US
Practice Address - Phone:660-646-3937
Practice Address - Fax:660-646-4092
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312590029Medicaid
MO4637030003Medicare NSC
MO410046877Medicare PIN
MO4637030002Medicare NSC
MO410049765Medicare PIN
MOT42439Medicare UPIN
MO410046913Medicare PIN
MO4637030001Medicare NSC
MO000091318Medicare PIN
MO312590029Medicaid
MOL536309Medicare PIN