Provider Demographics
NPI:1083941272
Name:ROBERT G SKELLEY PC
Entity Type:Organization
Organization Name:ROBERT G SKELLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-652-5603
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-0670
Mailing Address - Country:US
Mailing Address - Phone:563-652-5603
Mailing Address - Fax:563-323-0949
Practice Address - Street 1:204 N ARCADE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2006
Practice Address - Country:US
Practice Address - Phone:563-652-5603
Practice Address - Fax:563-323-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0156133Medicaid
IA21524Medicare PIN
IADU6885Medicare PIN
IAT01095Medicare UPIN
IA0156133Medicaid