Provider Demographics
NPI:1962758078
Name:SLAMA, AMY E (OD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:SLAMA
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 1:1630 ADAMS ST STE A
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4899
Mailing Address - Country:US
Mailing Address - Phone:507-345-6151
Mailing Address - Fax:507-625-1096
Practice Address - Street 1:1630 ADAMS ST STE A
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4899
Practice Address - Country:US
Practice Address - Phone:507-345-6151
Practice Address - Fax:507-625-1096
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2750152W00000X, 390200000X
MN3665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program