Basic Information
| Provider Information | |||||||||
| NPI: | 1194716449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOCUM-EDMONDS | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1987 SW 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972016016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032851671 | ||||||||
| FaxNumber: | 5032857859 | ||||||||
| Practice Location | |||||||||
| Address1: | 3246 N LOMBARD ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972171206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032851671 | ||||||||
| FaxNumber: | 5032857859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2152T | OR | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.