Healthcare Provider Details

I. General information

NPI: 1033101761
Provider Name (Legal Business Name): STEPHANIE A SKOLIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 13TH AVE SUITE 3B
HUNTINGTON WV
25701-3840
US

IV. Provider business mailing address

1616 13TH AVE SUITE 3B
HUNTINGTON WV
25701-3840
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-1404
  • Fax: 304-523-9763
Mailing address:
  • Phone: 304-525-1404
  • Fax: 304-523-9763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15984
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: