Provider Demographics
NPI:1033114525
Name:SKELTON, RAYMOND A (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:SKELTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-9727
Mailing Address - Country:US
Mailing Address - Phone:814-664-8985
Mailing Address - Fax:814-438-7976
Practice Address - Street 1:9239 ROUTE 6
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-9727
Practice Address - Country:US
Practice Address - Phone:814-438-2020
Practice Address - Fax:814-438-7976
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE6000394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0675621Medicaid
PA403556Medicare PIN
PA0675621Medicaid
PAT30181Medicare UPIN