Healthcare Provider Details

I. General information

NPI: 1356772883
Provider Name (Legal Business Name): RONALD SKOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVY EXCHANGE MITCHEL FIELD BLDG 16 RDS OPTICAL INC
GARDEN CITY NY
11530
US

IV. Provider business mailing address

NAVY EXCHANGE MITCHEL FIELD BLDG 16 RDS OPTICAL INC
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-6090
  • Fax: 516-745-1528
Mailing address:
  • Phone: 516-222-6090
  • Fax: 516-745-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number004481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: