Provider Demographics
NPI:1366551962
Name:SKUZA, RONALD JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:SKUZA
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 1:7111 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5345
Mailing Address - Country:US
Mailing Address - Phone:216-524-4525
Mailing Address - Fax:216-524-7211
Practice Address - Street 1:7111 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5345
Practice Address - Country:US
Practice Address - Phone:216-524-4525
Practice Address - Fax:216-524-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3498-T881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0624591Medicare Oscar/Certification
OHSK0624591Medicare ID - Type Unspecified
OH0624591Medicare PIN
OHT80573Medicare UPIN
OH0624591Medicare UPIN
OH0141010001Medicare NSC