Provider Demographics
NPI:1013977685
Name:LEVINE, PAUL E (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
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 1:30 TURNPIKE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2114
Mailing Address - Country:US
Mailing Address - Phone:508-481-8558
Mailing Address - Fax:
Practice Address - Street 1:30 TURNPIKE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2114
Practice Address - Country:US
Practice Address - Phone:508-481-8558
Practice Address - Fax:508-848-3057
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4028152W00000X, 152WL0500X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700347Medicaid
MA0700347Medicaid
MAU67948Medicare UPIN