Healthcare Provider Details

I. General information

NPI: 1578769865
Provider Name (Legal Business Name): JULIE SKOLFIELD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 JOHNSTON ST
LAFAYETTE LA
70503-3243
US

IV. Provider business mailing address

321 RICHLAND AVE
LAFAYETTE LA
70508-6612
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-1404
  • Fax: 337-234-2905
Mailing address:
  • Phone: 337-988-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number16-15844-1
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: