Provider Demographics
NPI:1992777221
Name:SLOWEY, LAURA J (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:SLOWEY
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 1:2709 ABBOTT CIR
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5330
Mailing Address - Country:US
Mailing Address - Phone:605-660-3896
Mailing Address - Fax:
Practice Address - Street 1:1601 CORNHUSKER DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3924
Practice Address - Country:US
Practice Address - Phone:402-494-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9202410Medicaid
41585Medicare ID - Type Unspecified
SD9202410Medicaid