MEDICARE: DARREN S LEVINE O.D.

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	OPT001339	GA

General Provider Information

NPI Number	:	1649214214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN S LEVINE O.D.

Provider Business Mailing Address
First Line	:	1197 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30361-3502
Country	:	US
Telephone Number	:	404-874-0474
Fax Number	:	404-872-5216

Provider Business Practice Location Address
First Line	:	1197 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30361-3502
Country	:	US
Telephone Number	:	404-874-0474
Fax Number	:	404-872-5216

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/16/2012

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