Provider Demographics
NPI:1568504074
Name:SKAROTE, LUCILLE M (OD)
Entity Type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:M
Last Name:SKAROTE
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 1:2224 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1842
Mailing Address - Country:US
Mailing Address - Phone:330-747-1221
Mailing Address - Fax:
Practice Address - Street 1:2224 5TH AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1842
Practice Address - Country:US
Practice Address - Phone:330-747-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8137448Medicaid