Provider Demographics
NPI:1225495922
Name:ROSALIA SAAVEDRA,OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSALIA SAAVEDRA,OD A PROFESSIONAL CORPORATION
Other - Org Name:SAN LEANDRO OPTOMETRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-483-4770
Mailing Address - Street 1:157 PARROTT ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4813
Mailing Address - Country:US
Mailing Address - Phone:510-483-4770
Mailing Address - Fax:510-351-5008
Practice Address - Street 1:157 PARROTT ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4813
Practice Address - Country:US
Practice Address - Phone:510-483-4770
Practice Address - Fax:510-351-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10781TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82016CAMedicare UPIN
CASD0107811Medicare PIN