Provider Demographics
NPI:1376542092
Name:LEVINGSTON, NORMA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:JEAN
Last Name:LEVINGSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 S WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4056
Mailing Address - Country:US
Mailing Address - Phone:408-238-9696
Mailing Address - Fax:408-238-4067
Practice Address - Street 1:3257 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4056
Practice Address - Country:US
Practice Address - Phone:408-238-9696
Practice Address - Fax:408-238-4067
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5558T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10037Medicare UPIN
CASD0055581Medicare PIN