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General NPI Number Information
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NPI Number | 1831506252
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Entity Type | Organization
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Legal Business Name | SAVAGE EYE CLINIC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 3930 CEDAR GROVE PKWY
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City | EAGAN
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State | MN
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Zip | 55122-1403
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Country | US
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Telephone | 651-454-5661
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Fax | 651-454-5669
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Provider Business Mailing Address
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Address Line | 5809 EGAN DR
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City | SAVAGE
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State | MN
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Zip | 55378-4918
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Country | US
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Telephone | 952-226-2020
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Fax | 952-226-2032
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | KRIS HAFFNER
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Credential |
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Telephone | 651-454-5661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6350254
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License Number State | MN
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