Healthcare Provider Details

I. General information

NPI: 1356349989
Provider Name (Legal Business Name): PHILIP M. SAVAGE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 STILLWATER AVE
BANGOR ME
04401-3614
US

IV. Provider business mailing address

824 STILLWATER AVE
BANGOR ME
04401-3614
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-7554
  • Fax: 207-945-0085
Mailing address:
  • Phone: 207-947-7554
  • Fax: 207-945-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT605
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: