Provider Demographics
NPI:1417924648
Name:LEVI, CHRISTINA J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:J
Last Name:LEVI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:406 E BROADWAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-2417
Practice Address - Country:US
Practice Address - Phone:618-462-7611
Practice Address - Fax:800-432-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009003152W00000X
MOTO3352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO126315OtherBLUE CHOICE
217290OtherGHP
43981OtherDAVIS VISION
OPO694OtherEYEMED
MO22-01500OtherUNITED HEALTHCARE
12448OtherOPTICARE MEDICARE COMPLET
IL046-009003Medicaid
1417924648OtherNPI
479374OtherHEALTLINK
MO126220OtherBLUE CROSS BLUE SHIELD MO
MO316017813Medicaid
IL410048079OtherRR MEDICARE
MO316017805Medicaid
MO126220OtherBLUE CROSS BLUE SHIELD MO
OPO694OtherEYEMED
MO22-01500OtherUNITED HEALTHCARE
IL1102128378001Medicare PIN