Provider Demographics
NPI:1558930107
Name:MILLIKIN, SAVANNAH BROOKE (OD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:BROOKE
Last Name:MILLIKIN
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 1:501 W MOFFETT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52585-9234
Mailing Address - Country:US
Mailing Address - Phone:812-701-4728
Mailing Address - Fax:
Practice Address - Street 1:2629 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9565
Practice Address - Country:US
Practice Address - Phone:319-338-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004272A152W00000X
KY2233DT152W00000X
IA122652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist