Provider Demographics
NPI:1154365815
Name:SKARNULIS, LAUREN ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:SKARNULIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:ZABOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8154 BEL CHERRIE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1637
Mailing Address - Country:US
Mailing Address - Phone:231-633-4210
Mailing Address - Fax:989-366-6390
Practice Address - Street 1:2129 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8236
Practice Address - Country:US
Practice Address - Phone:989-366-6344
Practice Address - Fax:989-366-6390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS004270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D010070OtherBLUE CROSS OF MICHIGAN
MI944767641Medicaid