Provider Demographics
NPI:1578568283
Name:LEVERETT, MARCIA K (OD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:K
Last Name:LEVERETT
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 1:812 S LYNNHAVEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6313
Mailing Address - Country:US
Mailing Address - Phone:757-486-2015
Mailing Address - Fax:757-486-0853
Practice Address - Street 1:812 S LYNNHAVEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6313
Practice Address - Country:US
Practice Address - Phone:757-486-2015
Practice Address - Fax:757-486-0853
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578568283OtherPHYSICIAN NPI
VAVAA101899Medicare PIN
VA410001138Medicare PIN
VA1578568283OtherPHYSICIAN NPI