Provider Demographics
NPI:1114101334
Name:LEVIN EYE CARE CENTER, P.C.
Entity Type:Organization
Organization Name:LEVIN EYE CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-659-3050
Mailing Address - Street 1:1334 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1631
Mailing Address - Country:US
Mailing Address - Phone:219-659-3050
Mailing Address - Fax:219-659-3053
Practice Address - Street 1:1334 119TH ST.
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394
Practice Address - Country:US
Practice Address - Phone:219-659-3050
Practice Address - Fax:219-659-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001641152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1336220458OtherNPI
IN456040Medicare PIN
IN1336220458OtherNPI
IN0265460001Medicare NSC