Provider Demographics
NPI:1174982953
Name:S.A.V.O.C L.L.C
Entity type:Organization
Organization Name:S.A.V.O.C L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:FASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-703-3350
Mailing Address - Street 1:2833 WEST RIDGE ROAD
Mailing Address - Street 2:PEARLE VISION RIDGEMONT PLAZA SUITE 'A'
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-703-3350
Mailing Address - Fax:
Practice Address - Street 1:2833 WEST RIDGE ROAD
Practice Address - Street 2:PEARLE VISION RIDGEMONT PLAZA SUITE 'A'
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-703-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006162-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization