Healthcare Provider Details

I. General information

NPI: 1265575989
Provider Name (Legal Business Name): MICHELE LEVY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BEACH ST
WESTERLY RI
02891-2770
US

IV. Provider business mailing address

55 BEACH ST
WESTERLY RI
02891-2770
US

V. Phone/Fax

Practice location:
  • Phone: 401-315-0002
  • Fax: 401-388-8395
Mailing address:
  • Phone: 401-315-0002
  • Fax: 401-388-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberCODTG00734
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberCODTG00734
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberCODTG00734
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberCODTG00734
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCT2257
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCODTG00734
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: