Provider Demographics
NPI:1285786517
Name:SKOLNICK, STANLEY D (OD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:D
Last Name:SKOLNICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2098 ROBERT FULTON HWY
Mailing Address - Street 2:
Mailing Address - City:PEACH BOTTOM
Mailing Address - State:PA
Mailing Address - Zip Code:17563-9614
Mailing Address - Country:US
Mailing Address - Phone:717-548-9925
Mailing Address - Fax:
Practice Address - Street 1:1834 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6463
Practice Address - Country:US
Practice Address - Phone:717-569-8688
Practice Address - Fax:717-509-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMS0535356OtherDEA NUMBER
PAU81822Medicare UPIN
PAMS0535356OtherDEA NUMBER