Provider Demographics
NPI:1033261904
Name:CHRISTINA J. LEVI O D P C
Entity Type:Organization
Organization Name:CHRISTINA J. LEVI O D P C
Other - Org Name:EDWARDSVILLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-462-9818
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6206
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:2100 TROY RD STE 104
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2595
Practice Address - Country:US
Practice Address - Phone:618-656-8888
Practice Address - Fax:314-741-4947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTINA J. LEVI O D P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
29111OtherSPECTERA
29111OtherSPECTERA
IL0471360029Medicare NSC