Provider Demographics
NPI:1467447094
Name:LEVIN, MARTIN JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAY
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 1:43041 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2279
Mailing Address - Country:US
Mailing Address - Phone:248-348-1330
Mailing Address - Fax:248-348-7107
Practice Address - Street 1:43041 7 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2279
Practice Address - Country:US
Practice Address - Phone:248-348-1330
Practice Address - Fax:248-348-7107
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2684218Medicaid
MIOH26871Medicare ID - Type Unspecified
MI2684218Medicaid