Provider Demographics
NPI:1558623108
Name:LEVACK, SHERI LYN (OD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LYN
Last Name:LEVACK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2011
Mailing Address - Country:US
Mailing Address - Phone:219-384-8838
Mailing Address - Fax:
Practice Address - Street 1:1251 US 31 N
Practice Address - Street 2:SPACE 130
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4503
Practice Address - Country:US
Practice Address - Phone:317-887-2732
Practice Address - Fax:317-887-1553
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003730A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist