Healthcare Provider Details

I. General information

NPI: 1023028263
Provider Name (Legal Business Name): SID E SAVITT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29610 EUCLID AVE
WICKLIFFE OH
44092-1829
US

IV. Provider business mailing address

29610 EUCLID AVE
WICKLIFFE OH
44092-1829
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-1993
  • Fax: 440-943-9595
Mailing address:
  • Phone: 440-943-1993
  • Fax: 440-943-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: