Provider Demographics
NPI:1255484895
Name:LEVY, CHARLES HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:LEVY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8106 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2053
Mailing Address - Country:US
Mailing Address - Phone:323-585-5411
Mailing Address - Fax:323-585-6515
Practice Address - Street 1:8106 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2053
Practice Address - Country:US
Practice Address - Phone:323-585-5411
Practice Address - Fax:323-585-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP6728T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0067280Medicaid
CASD0067280Medicaid
CAOP6728Medicare ID - Type Unspecified