1124371620 NPI number — SAVOCHKA EYE ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124371620 NPI number — SAVOCHKA EYE ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVOCHKA EYE ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124371620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4128 CRESCENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER SPRINGS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19425-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-760-8079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 LANCASTER AVE STE F5
Provider Second Line Business Practice Location Address:
LINCOLN COURT SHOPPING CENTER
Provider Business Practice Location Address City Name:
FRAZER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-760-8079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SAVOCHKA
Authorized Official First Name:
JASON
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-760-8079

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG 00132300 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10257772570001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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