Provider Demographics
NPI:1326191420
Name:SKOLNIK, MARSHALL RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:RICHARD
Last Name:SKOLNIK
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 1:3015 SLAYEN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4314
Mailing Address - Country:US
Mailing Address - Phone:858-483-3488
Mailing Address - Fax:858-483-0586
Practice Address - Street 1:6987 FRIARS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1100
Practice Address - Country:US
Practice Address - Phone:619-298-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist