Provider Demographics
NPI:1891861936
Name:SKILLMAN, JON A (O D)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:SKILLMAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 WILLIAMSBURG SQ
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6473
Mailing Address - Country:US
Mailing Address - Phone:270-684-7274
Mailing Address - Fax:270-684-3151
Practice Address - Street 1:233 WILLIAMSBURG SQ
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6473
Practice Address - Country:US
Practice Address - Phone:270-684-7274
Practice Address - Fax:270-684-3151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0773DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007730Medicaid
KYT54642Medicare UPIN
KY0694820001Medicare NSC
KY9116001Medicare PIN