Healthcare Provider Details

I. General information

NPI: 1962374892
Provider Name (Legal Business Name): SAVANNAH CLAIRE SKIDMORE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 SUMMER ST STE 212
STAMFORD CT
06905-4318
US

IV. Provider business mailing address

33 UNCAS RD
CLINTON CT
06413-2314
US

V. Phone/Fax

Practice location:
  • Phone: 203-975-1818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3473
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: