Provider Demographics
NPI:1689661977
Name:DR BERNARD LEVIN, DR D H DUNCAN & DR PERRY S HOM, AN OPTOMETRIC CORP
Entity Type:Organization
Organization Name:DR BERNARD LEVIN, DR D H DUNCAN & DR PERRY S HOM, AN OPTOMETRIC CORP
Other - Org Name:DRS DUNCAN, HOM, HORIBE AND GUTIERREZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-6448
Mailing Address - Street 1:592 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3467
Mailing Address - Country:US
Mailing Address - Phone:626-331-6448
Mailing Address - Fax:626-967-7006
Practice Address - Street 1:592 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3467
Practice Address - Country:US
Practice Address - Phone:626-331-6448
Practice Address - Fax:626-967-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-01
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9031126Medicaid
CA9031126Medicaid
CA0330910001Medicare NSC