Provider Demographics
NPI:1376501767
Name:LEVINSON, JAMES B (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:LEVINSON
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 1:14223 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1203
Mailing Address - Country:US
Mailing Address - Phone:708-849-0690
Mailing Address - Fax:708-849-0344
Practice Address - Street 1:14223 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1203
Practice Address - Country:US
Practice Address - Phone:708-849-0690
Practice Address - Fax:708-849-0344
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-0074685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38306Medicare UPIN
IL732540Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL410015390Medicare PIN
0143480001Medicare NSC