Individual
RENERICK S SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
23105 THREE NOTCH RD STE A, CALIFORNIA, MD 20619-2417
(301) 863-2020
(301) 863-2020
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0154
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001887
VA
152W00000X
Optometrist
Primary
TA2499
MD
Other
Enumeration date
08/28/2009
Last updated
03/18/2021
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