Provider Demographics
NPI:1235197138
Name:LEVIN, STELLA (OD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36167 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4755
Mailing Address - Country:US
Mailing Address - Phone:510-793-2484
Mailing Address - Fax:
Practice Address - Street 1:2687 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5409
Practice Address - Country:US
Practice Address - Phone:510-538-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12429T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA119851Medicare PIN
CAV01529Medicare UPIN