Provider Demographics
NPI: | 1508096611 |
---|---|
Name: | CHRISTOPHER PETER GREGG |
Entity Type: | Organization |
Organization Name: | CHRISTOPHER PETER GREGG |
Other - Org Name: | SAVAGE FAMILY EYE CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OPTICIAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRIS |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | GREGG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 651-455-1492 |
Mailing Address - Street 1: | 6175 CAHILL AVE STE 101 |
Mailing Address - Street 2: | |
Mailing Address - City: | INVER GROVE HEIGHTS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55076-1527 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-455-1492 |
Mailing Address - Fax: | 651-455-9466 |
Practice Address - Street 1: | 5809 EGAN DR |
Practice Address - Street 2: | |
Practice Address - City: | SAVAGE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55378-4918 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-388-7192 |
Practice Address - Fax: | 651-455-1492 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-07-23 |
Last Update Date: | 2023-04-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 156FX1800X | Eye and Vision Services Providers | Technician/Technologist | Optician | Group - Single Specialty |