Provider Demographics
NPI:1003999574
Name:SAAVEDRA, IVAN M (OD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:M
Last Name:SAAVEDRA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AVE ESTEVES
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-3025
Mailing Address - Country:US
Mailing Address - Phone:787-640-8517
Mailing Address - Fax:787-814-0707
Practice Address - Street 1:10 AVE ESTEVES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-3025
Practice Address - Country:US
Practice Address - Phone:787-640-8517
Practice Address - Fax:787-814-0707
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00-53081Medicare ID - Type Unspecified
PR195890Medicare UPIN