Healthcare Provider Details

I. General information

NPI: 1568905701
Provider Name (Legal Business Name): MICHELLE LEVIN OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 414
HIALEAH FL
33013-3835
US

IV. Provider business mailing address

777 E 25TH ST STE 414
HIALEAH FL
33013-3835
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-7588
  • Fax:
Mailing address:
  • Phone: 305-835-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4645
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME46223
License Number StateFL

VIII. Authorized Official

Name: MICHELLE LEVIN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 305-835-7588