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General NPI Number Information
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NPI Number | 1679645394
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Entity Type | Organization
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Legal Business Name | JON A. SKILLMAN
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 233 WILLIAMSBURG SQ
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City | OWENSBORO
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State | KY
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Zip | 42303-6473
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Country | US
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Telephone | 270-684-3234
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Fax | 270-684-3151
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Provider Business Mailing Address
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Address Line | 3625 TREEHAVEN BND
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City | OWENSBORO
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State | KY
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Zip | 42303-1785
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Country | US
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Telephone | 270-684-3234
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Fax | 270-684-3151
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Authorized Official
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Title or Position | OPTOMETRISTS
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Name | DR. JON A SKILLMAN
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Credential | O.D.
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Telephone | 270-684-3234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0773DT
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License Number State | KY
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