Provider Demographics
NPI:1528157393
Name:LEVITT, RONALD S (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:LEVITT
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 1:4 PLUMROSE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480
Mailing Address - Country:US
Mailing Address - Phone:860-342-4949
Mailing Address - Fax:860-342-4949
Practice Address - Street 1:420 BUCKLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-644-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3551054OtherOXFORD
5859283OtherCIGNA
090000692CT04OtherANTHEM BLUE CROSS
2V4056OtherHEALTHNET
3667972OtherAETNA
090000692CT05OtherANTHEM MANCHESTER
2200815OtherUNITED HC
5859283OtherCIGNA