Provider Demographics
NPI:1023075587
Name:RENTA-SKYER, VIVIAN L (OD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:L
Last Name:RENTA-SKYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5522
Mailing Address - Country:US
Mailing Address - Phone:631-231-2073
Mailing Address - Fax:631-231-2008
Practice Address - Street 1:1758 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5522
Practice Address - Country:US
Practice Address - Phone:631-231-2073
Practice Address - Fax:631-231-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC23781Medicaid
NYC23781Medicaid