Provider Demographics
NPI:1306004627
Name:SAVOY, CHRISTINE (ABOC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SAVOY
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8545 STAUFENBEIL RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9759
Mailing Address - Country:US
Mailing Address - Phone:608-576-7523
Mailing Address - Fax:
Practice Address - Street 1:N8545 STAUFENBEIL RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9759
Practice Address - Country:US
Practice Address - Phone:608-576-7523
Practice Address - Fax:608-429-4888
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38452300Medicaid