Healthcare Provider Details

I. General information

NPI: 1285152025
Provider Name (Legal Business Name): SKELTON EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 ROUTE 6
UNION CITY PA
16438-9727
US

IV. Provider business mailing address

11820 HUNTERS RIDGE BLVD APT 3
MEADVILLE PA
16335-6280
US

V. Phone/Fax

Practice location:
  • Phone: 814-438-2020
  • Fax: 814-438-7976
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003285
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1033187410001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. RACHELE MARGARET SIEGEL
Title or Position: PRESIDENT
Credential: OD
Phone: 814-657-8074