Healthcare Provider Details

I. General information

NPI: 1508838954
Provider Name (Legal Business Name): DAVENPORT EYE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 E RUSHOLME ST STE 203
DAVENPORT IA
52803-2400
US

IV. Provider business mailing address

1230 E RUSHOLME ST STE 203
DAVENPORT IA
52803-2400
US

V. Phone/Fax

Practice location:
  • Phone: 563-322-0923
  • Fax: 563-322-7403
Mailing address:
  • Phone: 563-322-0923
  • Fax: 563-322-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SIV BRIT SAETRE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 563-322-0923