Provider Demographics
NPI:1659058428
Name:PETERSON, SAVANNAH (OD)
Entity Type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18833 TOWN RIDGE LN APT 2201
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1625
Mailing Address - Country:US
Mailing Address - Phone:360-483-8283
Mailing Address - Fax:
Practice Address - Street 1:105 E PARKWOOD AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5727
Practice Address - Country:US
Practice Address - Phone:281-972-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist