Healthcare Provider Details

I. General information

NPI: 1396726535
Provider Name (Legal Business Name): SKYLINE OPTOMETRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 W TAFT RD
NORTH SYRACUSE NY
13212-2747
US

IV. Provider business mailing address

5349 W TAFT RD
NORTH SYRACUSE NY
13212-2747
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-8010
  • Fax: 315-458-8011
Mailing address:
  • Phone: 315-458-8010
  • Fax: 315-458-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0497030001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GERARD MORRA
Title or Position: OWNER
Credential: OD
Phone: 315-458-8010