Provider Demographics
NPI:1629459862
Name:EBELING, SLAYTON WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:SLAYTON
Middle Name:WILLIAM
Last Name:EBELING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 TRAVIS ST STE 170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1480
Mailing Address - Country:US
Mailing Address - Phone:214-522-2661
Mailing Address - Fax:
Practice Address - Street 1:3535 TRAVIS ST STE 170
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1480
Practice Address - Country:US
Practice Address - Phone:214-522-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8716T152W00000X
TX8716TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist