Provider Demographics
NPI:1568905701
Name:MICHELLE LEVIN OD PA
Entity Type:Organization
Organization Name:MICHELLE LEVIN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-835-7588
Mailing Address - Street 1:777 E 25TH ST STE 414
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3835
Mailing Address - Country:US
Mailing Address - Phone:305-835-7588
Mailing Address - Fax:
Practice Address - Street 1:777 E 25TH ST STE 414
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3835
Practice Address - Country:US
Practice Address - Phone:305-835-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4645152W00000X
FLME46223207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFO318ZMedicare PIN
FL004311500Medicaid