MEDICARE: RAYMOND A SKELTON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OE6000394	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033114525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND A SKELTON O.D.

Provider Business Mailing Address
First Line	:	9239 ROUTE 6
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-9727
Country	:	US
Telephone Number	:	814-664-8985
Fax Number	:	814-438-7976

Provider Business Practice Location Address
First Line	:	9239 ROUTE 6
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-9727
Country	:	US
Telephone Number	:	814-438-2020
Fax Number	:	814-438-7976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/05/2008

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