Provider Demographics
NPI:1952034274
Name:SKIDMORE, STEPHANIE NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6710 BABCOCK RD APT 936
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2890
Mailing Address - Country:US
Mailing Address - Phone:661-794-3401
Mailing Address - Fax:
Practice Address - Street 1:15900 LA CANTERA PKWY STE 9915
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2431
Practice Address - Country:US
Practice Address - Phone:210-694-5296
Practice Address - Fax:210-694-4932
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10622T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist