Provider Demographics
NPI:1972615391
Name:SKK OPTOMETRISTS LIMITED
Entity type:Organization
Organization Name:SKK OPTOMETRISTS LIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:POUYAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-997-1477
Mailing Address - Street 1:534 N RAND RD
Mailing Address - Street 2:C/O LAKE ZURICH EYECARE
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3103
Mailing Address - Country:US
Mailing Address - Phone:847-997-1477
Mailing Address - Fax:
Practice Address - Street 1:534 N RAND RD
Practice Address - Street 2:C/O LAKE ZURICH EYECARE
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3103
Practice Address - Country:US
Practice Address - Phone:847-997-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty