Provider Demographics
NPI:1154481042
Name:ROBERT D. LEVY PC
Entity Type:Organization
Organization Name:ROBERT D. LEVY PC
Other - Org Name:DRS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-386-0202
Mailing Address - Street 1:4423 ROUTE 130 S
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2385
Mailing Address - Country:US
Mailing Address - Phone:609-386-0202
Mailing Address - Fax:609-386-5927
Practice Address - Street 1:4423 ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2385
Practice Address - Country:US
Practice Address - Phone:609-386-0202
Practice Address - Fax:609-386-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00526400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066170Medicare PIN
NJ4560560001Medicare NSC