Active NPI
Renerick S Slack, OD
- Optometrist
- California, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA2499
- Practice address
- 23105 Three Notch Rd Ste a
California, MD 20619-2417 - Phone
- (301) 863-2020
- Fax
- (301) 863-2020
- NPI assigned
- Aug 28, 2009
- Last updated
- Mar 18, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618001887 | VA | |
| Optometrist | 152W00000X | TA2499 | MD | Primary |
Addresses
Primary practice location
23105 Three Notch Rd Ste a
California, MD 20619-2417
Mailing address
1950 Old Gallows Rd
Suite 520
Vienna, VA 22182-3990
Phone (703) 847-8899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Maryland, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Maryland, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Maryland, LLC | Optometrist | Current | Accepting new patients |
Locations
23105 Three Notch Rd
Ste A
California, MD 20619
Phone (301) 863-2020
2936 Festival Way
Ste 409A
Waldorf, MD 20601
Phone (301) 710-6919
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616025600000",
"number": "1144453812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD",
"address_2": "SUITE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823990",
"telephone_number": "703-847-8899",
"fax_number": "703-991-0154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23105 THREE NOTCH RD STE A",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206192417",
"telephone_number": "301-863-2020",
"fax_number": "301-863-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLACK",
"first_name": "RENERICK",
"middle_name": "S",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-28",
"last_updated": "2021-03-18",
"certification_date": "2021-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618001887",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA2499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in California, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.