Provider Demographics
NPI:1992735948
Name:SAVA, NICOLE THOA (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THOA
Last Name:SAVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17497 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6268
Mailing Address - Country:US
Mailing Address - Phone:760-948-3345
Mailing Address - Fax:
Practice Address - Street 1:17497 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6268
Practice Address - Country:US
Practice Address - Phone:760-948-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11731T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU92008Medicare UPIN
CA6204860001Medicare NSC