MEDICARE: STEPHANIE A SKOLIK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	15984	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033101761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE A SKOLIK MD

Provider Business Mailing Address
First Line	:	1616 13TH AVE
Second Line	:	SUITE 3B
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3840
Country	:	US
Telephone Number	:	304-525-1404
Fax Number	:	304-523-9763

Provider Business Practice Location Address
First Line	:	1616 13TH AVE
Second Line	:	SUITE 3B
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3840
Country	:	US
Telephone Number	:	304-525-1404
Fax Number	:	304-523-9763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	05/29/2008

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