Provider Demographics
NPI:1629031687
Name:SAVAGEAU, TIMOTHY E (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:SAVAGEAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:651-214-0847
Mailing Address - Fax:
Practice Address - Street 1:21260 CHIPPENDALE AVE W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1427
Practice Address - Country:US
Practice Address - Phone:651-463-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND476152W00000X
MN2269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN349823900Medicaid
T87211Medicare UPIN