Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1551 | WI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1551 | WI |
N | 152WS0006X | Sports Vision | 1551 | WI |
NPI | 1013999457 |
---|---|
Provider Name | Dr. Bruce A Savin |
First Address | Racine, WI 53403-2254 |
Second Address | Racine, WI 53403-2254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 16/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38515400 | (05) | WI |
T63193 | (02) | WI |