Provider Demographics
NPI:1386649697
Name:LEVY, LAWRENCE Z (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:Z
Last Name:LEVY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:64 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2357
Mailing Address - Country:US
Mailing Address - Phone:516-482-0129
Mailing Address - Fax:516-829-3126
Practice Address - Street 1:64 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2357
Practice Address - Country:US
Practice Address - Phone:516-482-0129
Practice Address - Fax:516-829-3126
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003112-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49041Medicare UPIN
NYC32401Medicare PIN
NYA400007070Medicare PIN