Provider Demographics
NPI:1487772067
Name:SLATON, CYNTHIA BULLARD (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:BULLARD
Last Name:SLATON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SIBELIUS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7203
Mailing Address - Country:US
Mailing Address - Phone:713-973-6233
Mailing Address - Fax:
Practice Address - Street 1:1313 N FRY RD STE A
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3343
Practice Address - Country:US
Practice Address - Phone:281-579-6939
Practice Address - Fax:281-579-2714
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4709T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX52719OtherDAVIS
TX03855OtherSPECTERA
TX18004510287OtherBLUE CROSS BLUE SHIELD
TX550768OtherNVA
TX550768OtherNVA