Provider Demographics
NPI:1093904310
Name:SKOKANDIC, NATALIE JUSTINA (OD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:JUSTINA
Last Name:SKOKANDIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 VIA DE ANZAR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6560
Mailing Address - Country:US
Mailing Address - Phone:857-205-7639
Mailing Address - Fax:
Practice Address - Street 1:1815 HAWTHORNE BLVD STE 236
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3437
Practice Address - Country:US
Practice Address - Phone:310-370-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13417 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist