Provider Demographics
NPI:1982689022
Name:SKIBA, GERALD ARTHUR II (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ARTHUR
Last Name:SKIBA
Suffix:II
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 1:2368 US 23 SOUTH
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-356-9096
Mailing Address - Fax:989-356-3968
Practice Address - Street 1:2368 US 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4546
Practice Address - Country:US
Practice Address - Phone:989-356-9096
Practice Address - Fax:989-356-3968
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGS003032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2712967Medicaid
MI2712967Medicaid
0B87610003Medicare ID - Type Unspecified