Healthcare Provider Details

I. General information

NPI: 1932022936
Provider Name (Legal Business Name): SKYLER GRAGG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 MAKALAPA RD
HONOLULU HI
96817
US

IV. Provider business mailing address

4773 REEF HERON CIR
JACKSONVILLE FL
32257-4104
US

V. Phone/Fax

Practice location:
  • Phone: 888-683-2778
  • Fax:
Mailing address:
  • Phone: 325-455-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: