Provider Demographics
NPI:1497990006
Name:DR. DERRICK SKAGGS AND ASSOCIATES PC
Entity Type:Organization
Organization Name:DR. DERRICK SKAGGS AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-369-7272
Mailing Address - Street 1:10920 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7352
Mailing Address - Country:US
Mailing Address - Phone:918-369-7272
Mailing Address - Fax:918-369-7010
Practice Address - Street 1:10920 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7352
Practice Address - Country:US
Practice Address - Phone:918-369-7272
Practice Address - Fax:918-369-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty