Provider Demographics
NPI:1669446878
Name:LEVINE, MARVIN N (OD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:N
Last Name:LEVINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15540 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3806
Mailing Address - Country:US
Mailing Address - Phone:734-422-5855
Mailing Address - Fax:734-422-8557
Practice Address - Street 1:15540 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-422-5855
Practice Address - Fax:734-422-8557
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP37880001Medicare PIN