Provider Demographics
NPI:1376584375
Name:LEVIN, RICHARD K (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:LEVIN
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 1:4313 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:415-529-1950
Mailing Address - Fax:410-529-9073
Practice Address - Street 1:4313 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2143
Practice Address - Country:US
Practice Address - Phone:410-529-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD293LMedicare PIN