Healthcare Provider Details

I. General information

NPI: 1124400130
Provider Name (Legal Business Name): STEFAN LEVAY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S MOORLAND RD STE B
BROOKFIELD WI
53005-7066
US

IV. Provider business mailing address

920 S MOORLAND RD STE B
BROOKFIELD WI
53005-7066
US

V. Phone/Fax

Practice location:
  • Phone: 262-955-1234
  • Fax: 262-955-1222
Mailing address:
  • Phone: 262-955-1234
  • Fax: 262-955-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3535-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: