Provider Demographics
NPI:1710022439
Name:LEVINE, A. SAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:SAUL
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 1:1101 S WINCHESTER BLVD STE E156
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3903
Mailing Address - Country:US
Mailing Address - Phone:408-244-8700
Mailing Address - Fax:408-244-9560
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:BUILDING E, SUITE 156
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-244-8700
Practice Address - Fax:408-244-9560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3537T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0035370Medicare ID - Type Unspecified
CAZZZ83645ZMedicare PIN
CAT76519Medicare UPIN
CA0322800001Medicare NSC