Active NPI
Robert J Slezak, OD
- Optometrist
- Gaylord, MI
National Provider Identifier
1528049079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003033
- Practice address
- 829 W Main St
Suite E
Gaylord, MI 49735-1998 - Phone
- (989) 732-6261
- Fax
- (989) 732-1276
- NPI assigned
- Nov 10, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003033 | MI | Primary |
Addresses
Primary practice location
829 W Main St
Suite E
Gaylord, MI 49735-1998
Mailing address
829 W Main St
Suite E
Gaylord, MI 49735-1998
Phone (989) 732-6261
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4325882 | Medicaid | MI | |
| OF9100 | Other | MI | BCBS MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311552000000",
"number": "1528049079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 W MAIN ST",
"address_2": "SUITE E",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497351998",
"telephone_number": "989-732-6261",
"fax_number": "989-732-1276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "829 W MAIN ST",
"address_2": "SUITE E",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497351998",
"telephone_number": "989-732-6261",
"fax_number": "989-732-1276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLEZAK",
"first_name": "ROBERT",
"middle_name": "J",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2011-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4325882",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MI",
"identifier": "OF9100",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.