Provider Demographics
NPI:1891791018
Name:LEVY, STEVEN R (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:LEVY
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 1:21411A 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2947
Mailing Address - Country:US
Mailing Address - Phone:718-225-5533
Mailing Address - Fax:718-225-5803
Practice Address - Street 1:21411A 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2947
Practice Address - Country:US
Practice Address - Phone:718-225-5533
Practice Address - Fax:718-225-5803
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4679152W00000X
NY320607146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49126Medicare UPIN
NYC3362Medicare ID - Type Unspecified