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General NPI Number Information
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NPI Number | 1568905701
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Entity Type | Organization
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Legal Business Name | MICHELLE LEVIN OD PA
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 777 E 25TH ST STE 414
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City | HIALEAH
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State | FL
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Zip | 33013-3835
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Country | US
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Telephone | 305-835-7588
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Fax |
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Provider Business Mailing Address
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Address Line | 777 E 25TH ST STE 414
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City | HIALEAH
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State | FL
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Zip | 33013-3835
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Country | US
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Telephone | 305-835-7588
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MICHELLE LEVIN
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Credential | O.D.
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Telephone | 305-835-7588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME46223
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License Number State | FL
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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 | OPC4645
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License Number State | FL
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