Provider Demographics
NPI:1124476171
Name:SKIBA, TYLER (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:SKIBA
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 1:2368 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4546
Mailing Address - Country:US
Mailing Address - Phone:989-356-9096
Mailing Address - Fax:989-356-3968
Practice Address - Street 1:2368 US HIGHWAY 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?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist