MEDICARE: SKYLINE OPTOMETRY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0497030001	NY
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1396726535	OTHER	NY	NPI

General Provider Information

NPI Number	:	1396726535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE OPTOMETRY, P.C.

Provider Business Mailing Address
First Line	:	5349 W TAFT RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2747
Country	:	US
Telephone Number	:	315-458-8010
Fax Number	:	315-458-8011

Provider Business Practice Location Address
First Line	:	5349 W TAFT RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2747
Country	:	US
Telephone Number	:	315-458-8010
Fax Number	:	315-458-8011

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH GERARD MORRA
Credential	:	OD
Telephone Number	:	315-458-8010

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	02/18/2022

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