Provider Demographics
NPI:1316940869
Name:SKLAR, JOEL (OD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SKLAR
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 1:1096 STRATHMORE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3826 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2013
Practice Address - Country:US
Practice Address - Phone:516-791-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00767208Medicaid
NY0235320001Medicare NSC
NYC30261Medicare ID - Type UnspecifiedBC/BS MC
NY03756Medicare ID - Type UnspecifiedGHI M.C.
NY00767208Medicaid