Healthcare Provider Details

I. General information

NPI: 1316940869
Provider Name (Legal Business Name): JOEL SKLAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 NOSTRAND AVE
BROOKLYN NY
11235-2013
US

IV. Provider business mailing address

1096 STRATHMORE ST
VALLEY STREAM NY
11581-2837
US

V. Phone/Fax

Practice location:
  • Phone: 516-791-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: