Healthcare Provider Details

I. General information

NPI: 1447546718
Provider Name (Legal Business Name): SHELLY LEE SKJOLAAS-LINDELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY LEE SKJOLAA O.D.

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 US HIGHWAY 51 AND 138 STE E
STOUGHTON WI
53589-2080
US

IV. Provider business mailing address

2300 US HIGHWAY 51 AND 138 STE E
STOUGHTON WI
53589-2080
US

V. Phone/Fax

Practice location:
  • Phone: 608-205-2293
  • Fax: 608-205-6813
Mailing address:
  • Phone: 608-205-2293
  • Fax: 608-205-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007713
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3402-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: