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General NPI Number Information
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NPI Number | 1184685729
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Entity Type | Individual
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Provider Name | KENNETH BENSON LEVINE O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 279 CAMBRIDGE STREET # 4 BURLINGTON EYE CARE
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City | BURLINGTON
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State | MA
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Zip | 01803
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Country | US
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Telephone | 781-272-7733
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Fax | 781-272-5740
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Provider Business Mailing Address
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Address Line | 279 CAMBRIDGE STREET # 4 BURLINGTON EYE CARE
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City | BURLINGTON
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State | MA
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Zip | 01803
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Country | US
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Telephone | 781-272-7733
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Fax | 781-272-5740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2745
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MA2745
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License Number State | MA
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