Provider Demographics
NPI:1487803201
Name:SKIBA VISION CENTER, PLLC
Entity type:Organization
Organization Name:SKIBA VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKIBA
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:989-356-9096
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGS003032332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6166770001Medicare NSC
T33897Medicare UPIN