Provider Demographics
NPI:1720124712
Name:DOUGLAS M. SAVERY, O.D., P.C.
Entity Type:Organization
Organization Name:DOUGLAS M. SAVERY, O.D., P.C.
Other - Org Name:DOUGLAS M SAVERY, O.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-864-5306
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27093979OtherSTATE COMP
AZAZ0901320OtherBCBS
AZ27093979OtherSTATE COMP
AZDS8557Medicare PIN
AZAZ0901320OtherBCBS
AZ27093979OtherSTATE COMP
AZ410047379Medicare PIN
AZ139099Medicaid