Provider Demographics
NPI:1073937462
Name:LEVIN EYE CARE PARTNERS, LLC
Entity Type:Organization
Organization Name:LEVIN EYE CARE PARTNERS, LLC
Other - Org Name:LEVIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-665-1779
Mailing Address - Street 1:4313 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2143
Mailing Address - Country:US
Mailing Address - Phone:410-665-1779
Mailing Address - Fax:410-668-0614
Practice Address - Street 1:106 CHARTLEY DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2321
Practice Address - Country:US
Practice Address - Phone:410-833-6622
Practice Address - Fax:410-526-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1863152W00000X
MDTA0654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1376584375Medicare UPIN
MD1073683371Medicare PIN