Provider Demographics
NPI:1962517292
Name:LEVEN, RICHARD L (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:LEVEN
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 1:468 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9225
Mailing Address - Country:US
Mailing Address - Phone:802-483-5367
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:468 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9225
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007949Medicaid
VTVT7949Medicare ID - Type Unspecified
VTT25412Medicare UPIN