Provider Demographics
NPI:1598140261
Name:LEVINSON EYE CARE CENTER
Entity Type:Organization
Organization Name:LEVINSON EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-263-8000
Mailing Address - Street 1:150 RIVER RD STE M2
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8941
Mailing Address - Country:US
Mailing Address - Phone:973-263-8000
Mailing Address - Fax:973-316-9644
Practice Address - Street 1:150 RIVER RD STE M2
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8941
Practice Address - Country:US
Practice Address - Phone:973-263-8000
Practice Address - Fax:973-316-9644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEVINSON EYE CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00013501152W00000X
NJ27OA00656400302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1659330322OtherNPI
NJ1417357575OtherNPI