Provider Demographics
NPI:1821077744
Name:SAVERY, DOUGLAS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:SAVERY
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 1:2511 E EVA LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1828
Mailing Address - Country:US
Mailing Address - Phone:928-864-5306
Mailing Address - Fax:928-779-7089
Practice Address - Street 1:1650 S MILTON RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0802
Practice Address - Country:US
Practice Address - Phone:928-864-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27093979OtherSTATE COMP
AZ139099Medicaid
AZAZ0901320OtherBLUECROSS/BLUESHIELD
AZ3879OtherAVESIS
AZ410047379Medicare PIN
AZ139099Medicaid
AZU01029Medicare UPIN
AZ1265790001Medicare NSC