MEDICARE: SKYLAR COURVILLE

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	11564TG	TX

General Provider Information

NPI Number	:	1982568796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR COURVILLE

Provider Business Mailing Address
First Line	:	109 SWEETGUM ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-1636
Country	:	US
Telephone Number	:	337-563-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 SWEETGUM ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-1636
Country	:	US
Telephone Number	:	337-563-8401
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ SKYLAR COURVILLE ” Practice Location

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