Provider Demographics
NPI:1033431424
Name:JONATHAN SAVELL, M.D., INC.
Entity Type:Organization
Organization Name:JONATHAN SAVELL, M.D., INC.
Other - Org Name:VALLEY EYECARE CENTER MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-460-5000
Mailing Address - Street 1:28 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4144
Mailing Address - Country:US
Mailing Address - Phone:925-449-4000
Mailing Address - Fax:925-606-6603
Practice Address - Street 1:28 FENTON ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4144
Practice Address - Country:US
Practice Address - Phone:925-449-4000
Practice Address - Fax:925-606-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
CA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G160910Medicaid
CA00G160910Medicaid
CA0464700002Medicare NSC