Provider Demographics
NPI:1952489429
Name:LEVINE, SANDER MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDER
Middle Name:MARK
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 1:7119 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4720
Mailing Address - Country:US
Mailing Address - Phone:718-268-7709
Mailing Address - Fax:718-268-7739
Practice Address - Street 1:7119 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4720
Practice Address - Country:US
Practice Address - Phone:718-268-7709
Practice Address - Fax:718-268-7739
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT4151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07518GMedicare ID - Type Unspecified
NYT81535Medicare UPIN