Provider Demographics
NPI:1659708527
Name:DANIEL J LEVIN OD PC
Entity Type:Organization
Organization Name:DANIEL J LEVIN OD PC
Other - Org Name:EYESITE ON 43RD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-235-3937
Mailing Address - Street 1:1695 43RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3317
Mailing Address - Country:US
Mailing Address - Phone:701-235-3937
Mailing Address - Fax:701-356-7886
Practice Address - Street 1:1695 43RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3317
Practice Address - Country:US
Practice Address - Phone:701-235-3937
Practice Address - Fax:701-356-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty