Provider Demographics
NPI:1831506252
Name:SAVAGE EYE CLINIC
Entity type:Organization
Organization Name:SAVAGE EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-454-5661
Mailing Address - Street 1:5809 EGAN DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4918
Mailing Address - Country:US
Mailing Address - Phone:952-226-2020
Mailing Address - Fax:952-226-2032
Practice Address - Street 1:3930 CEDAR GROVE PKWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1403
Practice Address - Country:US
Practice Address - Phone:651-454-5661
Practice Address - Fax:651-454-5669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGAN EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6350254152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty