Provider Demographics
NPI:1083801104
Name:MARIE R LEVINE OD
Entity Type:Organization
Organization Name:MARIE R LEVINE OD
Other - Org Name:LEVINE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-438-4418
Mailing Address - Street 1:33 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2167
Mailing Address - Country:US
Mailing Address - Phone:201-438-4418
Mailing Address - Fax:201-438-3082
Practice Address - Street 1:33 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2167
Practice Address - Country:US
Practice Address - Phone:201-438-4418
Practice Address - Fax:201-438-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00423300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT89074Medicare UPIN
NJ0578960001Medicare NSC
NJ848363Medicare PIN