Healthcare Provider Details

I. General information

NPI: 1861495517
Provider Name (Legal Business Name): ROBERT DEAN LEVY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 ROUTE 130 S
BURLINGTON NJ
08016-2385
US

IV. Provider business mailing address

4423 ROUTE 130 S
BURLINGTON NJ
08016-2385
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-0202
  • Fax: 609-386-5927
Mailing address:
  • Phone: 609-386-0202
  • Fax: 609-386-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5264
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: