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General NPI Number Information
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NPI Number | 1598140261
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Entity Type | Organization
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Legal Business Name | LEVINSON EYE CARE CENTER
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 150 RIVER RD STE M2
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City | MONTVILLE
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State | NJ
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Zip | 07045-8941
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Country | US
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Telephone | 973-263-8000
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Fax | 973-316-9644
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Provider Business Mailing Address
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Address Line | 150 RIVER RD STE M2
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City | MONTVILLE
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State | NJ
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Zip | 07045-8941
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Country | US
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Telephone | 973-263-8000
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Fax | 973-316-9644
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Authorized Official
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Title or Position | OPTOMETRY
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Name | DR. KEITH MICHAEL LEVINSON
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Credential | OD
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Telephone | 973-263-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 27OA00656400
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License Number State | NJ
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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 | 27OM00013501
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License Number State | NJ
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