Provider Demographics
NPI:1922040823
Name:SAVAGE, GARY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:SAVAGE
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 1:9623 32ND ST SE
Mailing Address - Street 2:SUITE D-121
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-2424
Mailing Address - Country:US
Mailing Address - Phone:425-377-9747
Mailing Address - Fax:425-377-8757
Practice Address - Street 1:9623 32ND ST SE
Practice Address - Street 2:D-121
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98205-2424
Practice Address - Country:US
Practice Address - Phone:425-377-9747
Practice Address - Fax:425-377-8757
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031821Medicaid
WAU01316Medicare UPIN