Provider Demographics
NPI:1235359415
Name:SKINNER, JUDITH M (OD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:SKINNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIELA
Other - Last Name:DEL PINO GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11103 WEST AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213
Mailing Address - Country:US
Mailing Address - Phone:210-524-6509
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:251 CLIFTON AVE
Practice Address - Street 2:EYE DRX
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1961
Practice Address - Country:US
Practice Address - Phone:973-340-2300
Practice Address - Fax:973-349-2306
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00608300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ112269CQTMedicare PIN