Provider Demographics
NPI:1306869383
Name:LEVIN, STEPHEN I (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:I
Last Name:LEVIN
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 1:9798 LEMONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-5448
Mailing Address - Country:US
Mailing Address - Phone:561-317-6833
Mailing Address - Fax:678-473-7933
Practice Address - Street 1:2605 PLEASANT HILL RD
Practice Address - Street 2:SUITE #200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1452
Practice Address - Country:US
Practice Address - Phone:678-473-4933
Practice Address - Fax:678-473-7933
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU96041Medicare UPIN