MEDICARE: DR. EDWARD R LEVY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3690	NJ
2	152W00000X	Optometrist	1560	NJ

General Provider Information

NPI Number	:	1427022235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD R LEVY OD

Provider Business Mailing Address
First Line	:	70 W ALLENDALE AVE
Second Line	:	ALLENDALE MED CENTER
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1798
Country	:	US
Telephone Number	:	201-327-1081
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 W ALLENDALE AVE
Second Line	:	ALLENDALE MED CENTER
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1798
Country	:	US
Telephone Number	:	201-327-1081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	12/04/2009

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