Organization
DAVENPORT EYE GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIV BRIT SAETRE M.D. (PRESIDENT)
(563) 322-0923
Entity
Organization
Contact information
Practice address
1230 E RUSHOLME ST, STE 203, DAVENPORT, IA 52803-2400
(563) 322-0923
(563) 322-7403
Mailing address
1230 E RUSHOLME ST, STE 203, DAVENPORT, IA 52803-2400
(563) 322-0923
(563) 322-7403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0286468
—
IA
01
—
CE7597
MEDICARE RR
—
Enumeration date
02/01/2006
Last updated
09/23/2009
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