Provider Demographics
NPI:1417732124
Name:SKAMAGOS, STEVE NICHOLAS
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:NICHOLAS
Last Name:SKAMAGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PREMIUM OUTLETS BLVD STE 860
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5524
Mailing Address - Country:US
Mailing Address - Phone:757-673-2504
Mailing Address - Fax:
Practice Address - Street 1:1600 PREMIUM OUTLETS BLVD STE 860
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5524
Practice Address - Country:US
Practice Address - Phone:757-673-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004567156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician