Basic Information
| Provider Information | |||||||||
| NPI: | 1639630841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOBODIN | ||||||||
| FirstName: | APRIL | ||||||||
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| Credential: | LDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 MERRICK RD # 30 | ||||||||
| Address2: | |||||||||
| City: | AMITYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117013455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316930041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 MERRICK RD # 30 | ||||||||
| Address2: | |||||||||
| City: | AMITYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117013455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316930041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2019 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 009158 | NY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.