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General NPI Number Information
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NPI Number | 1497990006
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Entity Type | Organization
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Legal Business Name | DR. DERRICK SKAGGS AND ASSOCIATES PC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 10920 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74133-7352
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Country | US
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Telephone | 918-369-7272
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Fax | 918-369-7010
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Provider Business Mailing Address
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Address Line | 10920 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74133-7352
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Country | US
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Telephone | 918-369-7272
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Fax | 918-369-7010
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. DERRICK OMER SKAGGS
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Credential | O.D.
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Telephone | 918-369-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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