Provider Demographics
NPI:1396952669
Name:DR FREDERICK E SLATER
Entity type:Organization
Organization Name:DR FREDERICK E SLATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMERTRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-377-1212
Mailing Address - Street 1:1875 SOUTH BASCOM AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2310
Mailing Address - Country:US
Mailing Address - Phone:408-377-1212
Mailing Address - Fax:408-377-3419
Practice Address - Street 1:1875 SOUTH BASCOM AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2310
Practice Address - Country:US
Practice Address - Phone:408-377-1212
Practice Address - Fax:408-377-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5101TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M50638241OtherDEA
M50638241OtherDEA
CASD0051010Medicare PIN